Provider Demographics
NPI:1821098955
Name:HALL, MONIQUE LENAE (AUD)
Entity Type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:LENAE
Last Name:HALL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-1803
Mailing Address - Country:US
Mailing Address - Phone:434-799-6288
Mailing Address - Fax:434-797-3685
Practice Address - Street 1:2104 LANGHORNE ROAD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501
Practice Address - Country:US
Practice Address - Phone:434-528-4245
Practice Address - Fax:434-797-3685
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201000563231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA640003591OtherMEDICARE RAILROAD PTAN - AUDIOLOGY HEARING AID ASSOCIATES, INC.
VA640003595OtherMEDICARE RAILROAD PTAN - DANNY W. GNEWIKOW, PH.D., LLC
VAVAA103121OtherMEDICARE PALMETTO GBA PTAN (AUDIOLOGY HEARING AID ASSOCIATES, INC.)
VA1821098955Medicaid
VA640000064OtherMEDICARE PALMETTO GBA PTAN (DANNY W. GNEWIKOW, PH.D., LLC)
VA540964595OtherPRIMARY PHYSICIAN CARE-DA
VA541361858OtherPIEDMONTCOMMUNITYHLTHPLAN
VA640000114Medicare ID - Type UnspecifiedMEDICARE TRAILBLAZER-LYN
VA640003595OtherRAILROAD-DANVILLE
VA322953OtherANTHEM OF VIRGINIA-LYN
VA640000064Medicare ID - Type UnspecifiedMEDICARE TRAILBLAZER-DAN
VA9450670Medicaid