Provider Demographics
NPI:1821031246
Name:HALL, RAELENE A (MACCC-SLP)
Entity type:Individual
Prefix:MS
First Name:RAELENE
Middle Name:A
Last Name:HALL
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12625 SE 61ST ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-3965
Mailing Address - Country:US
Mailing Address - Phone:206-764-2779
Mailing Address - Fax:206-764-2672
Practice Address - Street 1:1660 S COLUMBIAN WAY
Practice Address - Street 2:SPEECH PATHOLOGY S126
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1532
Practice Address - Country:US
Practice Address - Phone:206-764-2779
Practice Address - Fax:206-764-2672
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1871235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist