Provider Demographics
NPI:1154494433
Name:ZILL, MARYBETH (MS,CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:MARYBETH
Middle Name:
Last Name:ZILL
Suffix:
Gender:F
Credentials:MS,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 RANEY CT
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-5533
Mailing Address - Country:US
Mailing Address - Phone:408-296-8100
Mailing Address - Fax:
Practice Address - Street 1:1800 BROADWAY ST
Practice Address - Street 2:SUITE 5
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-2086
Practice Address - Country:US
Practice Address - Phone:650-299-2985
Practice Address - Fax:650-299-2990
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1092231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist