Provider Demographics
NPI:1295866564
Name:HILDEBRAND, KELLY MELISSA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MELISSA
Last Name:HILDEBRAND
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 CRIMSON CLOVER DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-7558
Mailing Address - Country:US
Mailing Address - Phone:501-258-0846
Mailing Address - Fax:
Practice Address - Street 1:1300 SOUTH BLVD.
Practice Address - Street 2:FAULKER COUNTY DAY SCHOOL
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034
Practice Address - Country:US
Practice Address - Phone:501-329-8102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2275235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist