Provider Demographics
NPI:1467821223
Name:WISDOM, HILARY (AUD)
Entity Type:Individual
Prefix:
First Name:HILARY
Middle Name:
Last Name:WISDOM
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 DELMAR ST
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-4138
Mailing Address - Country:US
Mailing Address - Phone:970-522-8622
Mailing Address - Fax:888-247-6747
Practice Address - Street 1:108 DELMAR ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-4138
Practice Address - Country:US
Practice Address - Phone:970-522-8622
Practice Address - Fax:888-247-6747
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-22
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO784231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist