Provider Demographics
NPI:1801194428
Name:HILD, LISA M (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:HILD
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8135 MCCAMIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-9010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1683 STATE ROUTE 49
Practice Address - Street 2:
Practice Address - City:CONSTANTIA
Practice Address - State:NY
Practice Address - Zip Code:13044-2602
Practice Address - Country:US
Practice Address - Phone:315-668-4207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-06
Last Update Date:2011-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016086235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist