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General NPI Number Information
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NPI Number | 1134071400
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Entity Type | Individual
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Provider Name | SAMMY JO HALLIS MS, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 02/10/2026
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Last Update Date | 02/10/2026
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Provider Practice Location Address
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Address Line | 29810 WICKERD RD
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City | MENIFEE
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State | CA
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Zip | 92584-8228
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Country | US
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Telephone | 951-723-3032
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Fax |
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Provider Business Mailing Address
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Address Line | 29521 SHIRE HORSE WAY
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City | MENIFEE
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State | CA
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Zip | 92584-1119
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Country | US
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Telephone | 951-264-7889
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP32164
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License Number State | CA
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