Provider Demographics
NPI:1598939076
Name:HALL, MARY ELLEN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
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 1:345 E OHIO ST
Mailing Address - Street 2:#1310
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3375
Mailing Address - Country:US
Mailing Address - Phone:312-527-2768
Mailing Address - Fax:
Practice Address - Street 1:2901 FINLEY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1041
Practice Address - Country:US
Practice Address - Phone:630-495-6800
Practice Address - Fax:630-495-8200
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146008610235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist