Provider Demographics
NPI:1407375512
Name:HALL, LISA THERESE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:THERESE
Last Name:HALL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O.BOX 23120
Mailing Address - Street 2:3820 NINE MILE RD. HENRICO PUBLIC SCHOOLS
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23223
Mailing Address - Country:US
Mailing Address - Phone:804-652-3600
Mailing Address - Fax:
Practice Address - Street 1:SKIPWITH ELEMENTARY SCHOOL
Practice Address - Street 2:2401 SKIPWITH RD.
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294
Practice Address - Country:US
Practice Address - Phone:804-527-4650
Practice Address - Fax:804-527-4664
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2203000325235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist