Provider Demographics
NPI:1760630115
Name:HALL, KATIE J (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:J
Last Name:HALL
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:J
Other - Last Name:IRWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 S NICOLE AVE
Mailing Address - Street 2:
Mailing Address - City:CROOKS
Mailing Address - State:SD
Mailing Address - Zip Code:57020-2006
Mailing Address - Country:US
Mailing Address - Phone:925-951-3462
Mailing Address - Fax:
Practice Address - Street 1:140 GREGORY LANE # 280
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-3360
Practice Address - Country:US
Practice Address - Phone:925-222-5353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
SD914235Z00000X
CA17734235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist