Provider Demographics
NPI:1720649072
Name:HALL, KARISSA JESSI (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KARISSA
Middle Name:JESSI
Last Name:HALL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KARISSA
Other - Middle Name:ANN
Other - Last Name:MOCCIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12842-0236
Mailing Address - Country:US
Mailing Address - Phone:203-550-5404
Mailing Address - Fax:
Practice Address - Street 1:163 STANTON RD
Practice Address - Street 2:
Practice Address - City:INDIAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:12842-7778
Practice Address - Country:US
Practice Address - Phone:315-221-3466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-27
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5904235Z00000X
NY029253235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist