Provider Demographics
NPI:1306074505
Name:HALL, MARY LOURDES (MS/ED-CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:LOURDES
Last Name:HALL
Suffix:
Gender:F
Credentials:MS/ED-CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 BARKER ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-4322
Mailing Address - Country:US
Mailing Address - Phone:518-452-2609
Mailing Address - Fax:
Practice Address - Street 1:27 BARKER ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-4322
Practice Address - Country:US
Practice Address - Phone:518-452-2609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005661-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist