Provider Demographics
NPI:1124463930
Name:MINTZ, HALLIE ELISE (MS)
Entity type:Individual
Prefix:MS
First Name:HALLIE
Middle Name:ELISE
Last Name:MINTZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 N 25TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-1834
Mailing Address - Country:US
Mailing Address - Phone:908-917-0472
Mailing Address - Fax:
Practice Address - Street 1:856 N 25TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-1834
Practice Address - Country:US
Practice Address - Phone:908-917-0472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTL-2221235Z00000X
PASL011774235Z00000X
NJ41YS00750900235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist