MEDICARE: SUSAN E HALL SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP-1946	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043521271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN E HALL SLP

Provider Business Mailing Address
First Line	:	141 SUSIE DR
Second Line	:
City	:	ST MARIES
State	:	ID
Zip	:	83861-9527
Country	:	US
Telephone Number	:	208-582-3605
Fax Number	:	208-245-2138

Provider Business Practice Location Address
First Line	:	820 ELM DR
Second Line	:
City	:	ST MARIES
State	:	ID
Zip	:	83861-2119
Country	:	US
Telephone Number	:	208-245-4576
Fax Number	:	208-245-2138

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2010
Last Update Date	:	06/22/2010

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Directions to “ SUSAN E HALL SLP” Practice Location

Language	Start Address	Practice Location

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