Healthcare Provider Details

I. General information

NPI: 1992365308
Provider Name (Legal Business Name): AUDREY A HALL SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 E COLONIAL DR STE 107
ORLANDO FL
32803-5200
US

IV. Provider business mailing address

10263 DWELL CT APT 302
ORLANDO FL
32832-6079
US

V. Phone/Fax

Practice location:
  • Phone: 407-898-5060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI3997
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: