Provider Demographics
NPI:1487879011
Name:HALL, CARLA C (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:C
Last Name:HALL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MISS
Other - First Name:CARLA
Other - Middle Name:C
Other - Last Name:CONOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:2836 REVERE CT
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-5889
Mailing Address - Country:US
Mailing Address - Phone:407-699-7269
Mailing Address - Fax:
Practice Address - Street 1:1555 HOWELL BRANCH RD
Practice Address - Street 2:SUITE B-1
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-1109
Practice Address - Country:US
Practice Address - Phone:407-645-2081
Practice Address - Fax:407-645-4574
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6304235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist