Provider Demographics
NPI:1780005660
Name:HALLBERG, LAINE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAINE
Middle Name:
Last Name:HALLBERG
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 1:640 ENTERPRISE DR
Mailing Address - Street 2:STE. C
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-9440
Mailing Address - Country:US
Mailing Address - Phone:614-433-0132
Mailing Address - Fax:614-433-0132
Practice Address - Street 1:640 ENTERPRISE DR
Practice Address - Street 2:STE. C
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-9440
Practice Address - Country:US
Practice Address - Phone:614-433-0132
Practice Address - Fax:614-433-0132
Is Sole Proprietor?:No
Enumeration Date:2013-12-19
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.11260235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist