Provider Demographics
NPI:1053776922
Name:HALL, MICHAEL S (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:HALL
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 GLASS AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40505-4110
Mailing Address - Country:US
Mailing Address - Phone:859-803-6604
Mailing Address - Fax:
Practice Address - Street 1:103 WINDSOR PATH
Practice Address - Street 2:SUITE 4
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9610
Practice Address - Country:US
Practice Address - Phone:502-863-3870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY13-037235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist