Provider Demographics
NPI:1417303876
Name:HALL, SAMANTHA J (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:J
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 1:4912 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-2456
Mailing Address - Country:US
Mailing Address - Phone:402-657-4027
Mailing Address - Fax:
Practice Address - Street 1:4912 WALNUT ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-2456
Practice Address - Country:US
Practice Address - Phone:402-657-4027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM$$$$$$$$$OtherSSN