MEDICARE: MS. KIMBERLY ELAINE HALE CCC-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	SP.03879	OH

General Provider Information

NPI Number	:	1134352743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY ELAINE HALE CCC-SLP

Provider Business Mailing Address
First Line	:	3750 OLD STATE ROUTE 56
Second Line	:
City	:	NEW MARSHFIELD
State	:	OH
Zip	:	45766-9763
Country	:	US
Telephone Number	:	740-591-9041
Fax Number	:

Provider Business Practice Location Address
First Line	:	3750 OLD STATE ROUTE 56
Second Line	:
City	:	NEW MARSHFIELD
State	:	OH
Zip	:	45766-9763
Country	:	US
Telephone Number	:	740-591-9041
Fax Number	:

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

Provider Enumeration Date	:	08/29/2009
Last Update Date	:	04/17/2024

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