Healthcare Provider Details

I. General information

NPI: 1376212928
Provider Name (Legal Business Name): NICOLE HALL SLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 EASTERN AVE
ROCHESTER NH
03867-2007
US

IV. Provider business mailing address

17 MILLERS FARM DR
ROCHESTER NH
03868-8831
US

V. Phone/Fax

Practice location:
  • Phone: 603-332-2848
  • Fax: 603-330-0838
Mailing address:
  • Phone: 603-285-5992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number0182
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: