Provider Demographics
NPI:1578836656
Name:HALL, OLISA RENEE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:OLISA
Middle Name:RENEE
Last Name:HALL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3507 DIXON ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-4214
Mailing Address - Country:US
Mailing Address - Phone:240-383-0406
Mailing Address - Fax:
Practice Address - Street 1:3507 DIXON ST
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-4214
Practice Address - Country:US
Practice Address - Phone:240-383-0406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-20
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06555235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist