MEDICARE: MICHAEL S HALL MS, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	13-037	KY

General Provider Information

NPI Number	:	1053776922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL S HALL MS, CCC-SLP

Provider Business Mailing Address
First Line	:	104 GLASS AVE
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40505-4110
Country	:	US
Telephone Number	:	859-803-6604
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 WINDSOR PATH
Second Line	:	SUITE 4
City	:	GEORGETOWN
State	:	KY
Zip	:	40324-9610
Country	:	US
Telephone Number	:	502-863-3870
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2015
Last Update Date	:	12/21/2015

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