Provider Demographics
NPI:1851625008
Name:HALL, MARY ELIZABETH (MSP, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELIZABETH
Last Name:HALL
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1801 OLD TROLLEY RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8283
Mailing Address - Country:US
Mailing Address - Phone:843-871-3235
Mailing Address - Fax:843-871-3233
Practice Address - Street 1:1801 OLD TROLLEY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8283
Practice Address - Country:US
Practice Address - Phone:843-871-3235
Practice Address - Fax:843-871-3233
Is Sole Proprietor?:No
Enumeration Date:2009-09-21
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1051235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist