Provider Demographics
NPI:1972004091
Name:HALLS, SARAH (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:HALLS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3645 GRAND AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-2040
Mailing Address - Country:US
Mailing Address - Phone:510-835-2757
Mailing Address - Fax:
Practice Address - Street 1:3645 GRAND AVE STE 304
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-2040
Practice Address - Country:US
Practice Address - Phone:510-835-2757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25648235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist