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1720649072 NPI number — KARISSA JESSI HALL MS, CCC-SLP

NPI Number: 1720649072
Health Care Provider/Practitioner: KARISSA JESSI HALL MS, CCC-SLP

Information about “1720649072” NPI (KARISSA JESSI HALL MS, CCC-SLP) exists in 1720649072 in HTML format HTML  |  1720649072 in plain Text format TXT  |  1720649072 in PDF (Portable Document Format) PDF  |  1720649072 in an XML format XML  formats.

NPI Number : 1720649072 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1720649072",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HALL",
    "FirstName": "KARISSA",
    "MiddleName": "JESSI",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MS, CCC-SLP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MOCCIO",
    "OtherFirstName": "KARISSA",
    "OtherMiddleName": "ANN",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MS, CCC-SLP",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "PO BOX 236",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "INDIAN LAKE",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "12842-0236",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "203-550-5404",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "163 STANTON RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "INDIAN LAKE",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "12842-7778",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "315-221-3466",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/27/2019",
    "LastUpdateDate": "08/29/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "5904",
          "LicenseNumberStateCode": "CT",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "029253",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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