Healthcare Provider Details

I. General information

NPI: 1053223461
Provider Name (Legal Business Name): HALLE L TIMM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3365 CRUGER AVE
BRONX NY
10467-6826
US

IV. Provider business mailing address

114 S 1ST ST APT 3
BROOKLYN NY
11249-4242
US

V. Phone/Fax

Practice location:
  • Phone: 718-379-2229
  • Fax:
Mailing address:
  • Phone: 763-274-9540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: