MEDICARE: MS. MARY ELIZABETH HALL M.S. 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	SA3319	FL

General Provider Information

NPI Number	:	1285103465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY ELIZABETH HALL M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	890 N FEDERAL HWY APT 105
Second Line	:
City	:	LANTANA
State	:	FL
Zip	:	33462-1846
Country	:	US
Telephone Number	:	954-812-7086
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 N ROSEMARY AVE
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-4133
Country	:	US
Telephone Number	:	561-714-6968
Fax Number	:

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

Provider Enumeration Date	:	11/17/2018
Last Update Date	:	11/17/2018

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Directions to “ MS. MARY ELIZABETH HALL M.S. CCC-SLP” Practice Location

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