MEDICARE: PATRICIA H HALL MA, CCC

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	10476	OR

General Provider Information

NPI Number	:	1538189485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA H HALL MA, CCC

Provider Business Mailing Address
First Line	:	6160 SE EASTBROOK DR
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-3239
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4029 NE TILLAMOOK ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-5341
Country	:	US
Telephone Number	:	503-249-0455
Fax Number	:

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	07/08/2007

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