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NPI Code Detail

MEDICARE: FREDERICK HALL

MEDICARE: FREDERICK HALL
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
1235Z00000XSpeech-Language PathologistSLP4489AZ

General Provider Information

NPI Number : 1912114729
Entity Type Code : Individual
Provider Name (Legal Business Name) : FREDERICK HALL
Provider Business Mailing Address
First Line : 13609 W CARIBBEAN LN
Second Line :
City : SURPRISE
State : AZ
Zip : 85379-8329
Country : US
Telephone Number : 623-584-2794
Fax Number :
Provider Business Practice Location Address
First Line : 1617 S 67TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85043-7717
Country : US
Telephone Number : 623-707-2251
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2007
Last Update Date : 07/08/2007

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Directions to “ FREDERICK HALL ” Practice Location

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