MEDICARE: BRANDI HALL CCCSLP,NCBOESLPA,MS

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	6196	NC

General Provider Information

NPI Number	:	1801723069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDI HALL CCCSLP,NCBOESLPA,MS

Provider Business Mailing Address
First Line	:	159 THORNECLIFFE DR
Second Line	:
City	:	STATE ROAD
State	:	NC
Zip	:	28676-9240
Country	:	US
Telephone Number	:	336-366-7085
Fax Number	:

Provider Business Practice Location Address
First Line	:	202 W SPRING ST
Second Line	:
City	:	ELKIN
State	:	NC
Zip	:	28621-3449
Country	:	US
Telephone Number	:	336-835-3151
Fax Number	:

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

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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