Provider Demographics
NPI:1851595276
Name:HALL, RITA M (CCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:RITA
Middle Name:M
Last Name:HALL
Suffix:
Gender:F
Credentials:CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24313 OAKLAWN PLANTATION RD
Mailing Address - Street 2:
Mailing Address - City:PASS CHRISTIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39571-8967
Mailing Address - Country:US
Mailing Address - Phone:228-452-5100
Mailing Address - Fax:
Practice Address - Street 1:24313 OAKLAWN PLANTATION RD
Practice Address - Street 2:
Practice Address - City:PASS CHRISTIAN
Practice Address - State:MS
Practice Address - Zip Code:39571-8967
Practice Address - Country:US
Practice Address - Phone:228-452-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS2785235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS40762258OtherTRICARE