Basic Information
| Provider Information | |||||||||
| NPI: | 1518534262 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WAILL | ||||||||
| FirstName: | NOLA | ||||||||
| MiddleName: | ANNABELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 227 MT HOLLY RD | ||||||||
| Address2: | |||||||||
| City: | KATONAH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105363543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149608610 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2085 INLAND DR STE A | ||||||||
| Address2: | |||||||||
| City: | NORTH BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974591203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412675221 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2021 | ||||||||
| LastUpdateDate: | 06/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 17152 | OR | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.