Basic Information
Provider Information
NPI: 1003007899
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HALL
FirstName: BRITTANY
MiddleName: LYNN
NamePrefix:  
NameSuffix:  
Credential: M.S. CCC-SLP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3601 4TH ST
Address2: # 2A300
City: LUBBOCK
State: TX
PostalCode: 794306073
CountryCode: US
TelephoneNumber: 8067432898
FaxNumber: 8067432787
Practice Location
Address1: 3601 4TH STREETE STE 2A300
Address2:  
City: LUBBOCK
State: TX
PostalCode: 794306073
CountryCode: US
TelephoneNumber: 8067435678
FaxNumber: 8067435670
Other Information
ProviderEnumerationDate: 08/06/2007
LastUpdateDate: 05/15/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X24543TXY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

ID Information
IDTypeStateIssuerDescription
18846110205TX MEDICAID


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