Provider Demographics
NPI:1942344080
Name:HALLER, RAPHAEL M
Entity Type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:M
Last Name:HALLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 ASHLEY RIVER ROAD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-5315
Mailing Address - Country:US
Mailing Address - Phone:843-766-3888
Mailing Address - Fax:843-766-3478
Practice Address - Street 1:1313 ASHLEY RIVER ROAD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5315
Practice Address - Country:US
Practice Address - Phone:843-766-3888
Practice Address - Fax:843-766-3478
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC410235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist