Provider Demographics
NPI:1710279575
Name:NALL, MISTY (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:NALL
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:
Other - Last Name:REDDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:5445 LEXINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-5964
Mailing Address - Country:US
Mailing Address - Phone:409-673-8291
Mailing Address - Fax:
Practice Address - Street 1:5445 LEXINGTON CIR
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:TX
Practice Address - Zip Code:77657-5964
Practice Address - Country:US
Practice Address - Phone:409-673-8291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104557235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist