MEDICARE: MARY AUDRAH HALL

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	6385	OK
2	235Z00000X	Speech-Language Pathologist	202660	AR

General Provider Information

NPI Number	:	1205513421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY AUDRAH HALL

Provider Business Mailing Address
First Line	:	470477 E 1125 RD
Second Line	:
City	:	MULDROW
State	:	OK
Zip	:	74948-7438
Country	:	US
Telephone Number	:	918-315-7599
Fax Number	:

Provider Business Practice Location Address
First Line	:	1117 S DOUGLAS BLVD STE F
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-5265
Country	:	US
Telephone Number	:	405-259-9478
Fax Number	:	405-259-8332

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

Provider Enumeration Date	:	06/29/2023
Last Update Date	:	07/07/2025

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Directions to “ MARY AUDRAH HALL ” Practice Location

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