Provider Demographics
NPI:1932314945
Name:HALL, KAREN K (MS, CCC)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:K
Last Name:HALL
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-5115
Mailing Address - Country:US
Mailing Address - Phone:631-543-2031
Mailing Address - Fax:631-543-2031
Practice Address - Street 1:57 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5115
Practice Address - Country:US
Practice Address - Phone:631-543-2031
Practice Address - Fax:631-543-2031
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001492-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist