Provider Demographics
NPI:1891990230
Name:HALL, JOHN W (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:HALL
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 BOUNTY ACRES W
Mailing Address - Street 2:
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512-7948
Mailing Address - Country:US
Mailing Address - Phone:843-479-0457
Mailing Address - Fax:843-479-5469
Practice Address - Street 1:1170 LINKHAW RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2524
Practice Address - Country:US
Practice Address - Phone:910-671-1163
Practice Address - Fax:910-671-4624
Is Sole Proprietor?:No
Enumeration Date:2007-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3154Medicaid
SC1133Medicaid
NC3154Medicare ID - Type Unspecified
SC1133Medicaid