Provider Demographics
NPI:1699087965
Name:HALL, MELISSA (AUD, CCC-A/SLP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:AUD, CCC-A/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 SW ARCHER RD RM D2-057
Mailing Address - Street 2:DEPARTMENT OF SPEECH, LANGUAGE, AND HEARING SCIENCES
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-3003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD RM D2-057
Practice Address - Street 2:DEPARTMENT OF SPEECH, LANGUAGE, AND HEARING SCIENCES
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-273-6185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY 1675231H00000X
FLSA 9689235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC426521Medicaid
SC426521Medicaid