Provider Demographics
NPI:1285867937
Name:HILL, LAURIE W (SLP, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:W
Last Name:HILL
Suffix:
Gender:F
Credentials:SLP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 E DEVLIN AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-1719
Mailing Address - Country:US
Mailing Address - Phone:706-540-3233
Mailing Address - Fax:
Practice Address - Street 1:1405 E DEVLIN AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-1719
Practice Address - Country:US
Practice Address - Phone:706-540-3233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-28
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP001305235Z00000X
AZSLP 6735235Z00000X
TX105690235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA208565070AMedicaid