Provider Demographics
NPI:1295075067
Name:HALL, JODI DAWN-MARIE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:DAWN-MARIE
Last Name:HALL
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 1:12488 SE PLANDOME DR
Mailing Address - Street 2:
Mailing Address - City:HOBE SOUND
Mailing Address - State:FL
Mailing Address - Zip Code:33455-7918
Mailing Address - Country:US
Mailing Address - Phone:772-546-7002
Mailing Address - Fax:
Practice Address - Street 1:12488 SE PLANDOME DR
Practice Address - Street 2:
Practice Address - City:HOBE SOUND
Practice Address - State:FL
Practice Address - Zip Code:33455-7918
Practice Address - Country:US
Practice Address - Phone:772-546-7002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA2762235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist