Provider Demographics
NPI:1780944504
Name:HALL, VICKI LYNN (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:VICKI
Middle Name:LYNN
Last Name:HALL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11B ATLANTIC OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-6876
Mailing Address - Country:US
Mailing Address - Phone:904-471-6687
Mailing Address - Fax:
Practice Address - Street 1:11B ATLANTIC OAKS CIR
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-6876
Practice Address - Country:US
Practice Address - Phone:904-471-6697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-26
Last Update Date:2012-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA299235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist