Provider Demographics
NPI:1639408008
Name:HIBBARD, SHIRLEY (MA CF-SLP)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:
Last Name:HIBBARD
Suffix:
Gender:F
Credentials:MA CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 W SUMMIT CIR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-4246
Mailing Address - Country:US
Mailing Address - Phone:540-514-0020
Mailing Address - Fax:
Practice Address - Street 1:5000 W SUMMIT CIR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4246
Practice Address - Country:US
Practice Address - Phone:540-514-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4111235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist