MEDICARE: MRS. MARY ELIZABETH HALL MSP, 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	1051	SC

General Provider Information

NPI Number	:	1851625008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY ELIZABETH HALL MSP, CCC-SLP

Provider Business Mailing Address
First Line	:	1801 OLD TROLLEY RD
Second Line	:	SUITE 101
City	:	SUMMERVILLE
State	:	SC
Zip	:	29485-8283
Country	:	US
Telephone Number	:	843-871-3235
Fax Number	:	843-871-3233

Provider Business Practice Location Address
First Line	:	1801 OLD TROLLEY RD
Second Line	:	SUITE 101
City	:	SUMMERVILLE
State	:	SC
Zip	:	29485-8283
Country	:	US
Telephone Number	:	843-871-3235
Fax Number	:	843-871-3233

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

Provider Enumeration Date	:	09/21/2009
Last Update Date	:	04/09/2013

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