Provider Demographics
NPI:1699269373
Name:HALL, MALLORY SEAL (CF-SLP)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:SEAL
Last Name:HALL
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:MALLORY
Other - Middle Name:LAMBETH
Other - Last Name:SEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3420 COTTONTAIL CHASE
Mailing Address - Street 2:
Mailing Address - City:GOOCHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23063-2737
Mailing Address - Country:US
Mailing Address - Phone:804-980-1487
Mailing Address - Fax:
Practice Address - Street 1:7246 FOREST HILL AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-1524
Practice Address - Country:US
Practice Address - Phone:804-320-7901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202008743235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist