Provider Demographics
NPI:1972759694
Name:HILBERG, MARY SARAH (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SARAH
Last Name:HILBERG
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:SARAH
Other - Last Name:ABOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:246 W HOMESTEAD ST
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-3130
Mailing Address - Country:US
Mailing Address - Phone:330-952-0953
Mailing Address - Fax:
Practice Address - Street 1:555 SPRINGBROOK DR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3651
Practice Address - Country:US
Practice Address - Phone:330-725-3393
Practice Address - Fax:330-725-6771
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP5727235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist