Provider Demographics
NPI:1285130393
Name:HALL, JAYNE
Entity type:Individual
Prefix:
First Name:JAYNE
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 ALVEY PARK DR W
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-2139
Mailing Address - Country:US
Mailing Address - Phone:270-683-9992
Mailing Address - Fax:
Practice Address - Street 1:3117 ALVEY PARK DR W
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-2139
Practice Address - Country:US
Practice Address - Phone:270-683-9992
Practice Address - Fax:270-683-9993
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY139813235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist