Provider Demographics
NPI:1376293571
Name:HALLETT, LILLIAN KATE (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:KATE
Last Name:HALLETT
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 NW CHRYSTAL DR
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-2553
Mailing Address - Country:US
Mailing Address - Phone:503-857-6435
Mailing Address - Fax:
Practice Address - Street 1:14780 SW OSPREY DR STE 285
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-8073
Practice Address - Country:US
Practice Address - Phone:503-579-7327
Practice Address - Fax:503-974-0946
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17146235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty