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General NPI Number Information
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NPI Number | 1720649072
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Entity Type | Individual
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Provider Name | KARISSA JESSI HALL MS, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 06/27/2019
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Last Update Date | 08/29/2023
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Provider Practice Location Address
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Address Line | 163 STANTON RD
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City | INDIAN LAKE
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State | NY
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Zip | 12842-7778
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Country | US
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Telephone | 315-221-3466
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 236
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City | INDIAN LAKE
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State | NY
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Zip | 12842-0236
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Country | US
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Telephone | 203-550-5404
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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 | 5904
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 029253
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License Number State | NY
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