Provider Demographics
NPI:1417185265
Name:HALL, CAROLYN R (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:R
Last Name:HALL
Suffix:
Gender:F
Credentials:MS, 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 166
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:TX
Mailing Address - Zip Code:78358-0168
Mailing Address - Country:US
Mailing Address - Phone:361-765-1881
Mailing Address - Fax:
Practice Address - Street 1:507 CACTUS
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:TX
Practice Address - Zip Code:78358-0166
Practice Address - Country:US
Practice Address - Phone:361-765-1881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15633235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist