Healthcare Provider Details

I. General information

NPI: 1497573539
Provider Name (Legal Business Name): REBA HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 MAIN ST. PO BOX #2
OAKLAND KY
42159-9701
US

IV. Provider business mailing address

102 MAIN ST PO BOX #2
OAKLAND KY
42159-9701
US

V. Phone/Fax

Practice location:
  • Phone: 615-745-9004
  • Fax:
Mailing address:
  • Phone: 615-745-9004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number306211
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: