Provider Demographics
NPI:1740475037
Name:HALL, MICHELLE AMOSSON (AUD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:AMOSSON
Last Name:HALL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LOUISE
Other - Last Name:AMOSSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:675 N SAINT CLAIR ST
Mailing Address - Street 2:STE 15-200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5975
Mailing Address - Country:US
Mailing Address - Phone:312-695-8182
Mailing Address - Fax:
Practice Address - Street 1:675 N SAINT CLAIR ST
Practice Address - Street 2:GALTER 15-200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5975
Practice Address - Country:US
Practice Address - Phone:312-695-8182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147-001251231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist