Provider Demographics
NPI:1184127706
Name:HILLARD, MARISSA BETH (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:BETH
Last Name:HILLARD
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 1:872 STILLHOUSE HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-9456
Mailing Address - Country:US
Mailing Address - Phone:502-229-4842
Mailing Address - Fax:
Practice Address - Street 1:872 STILLHOUSE HOLLOW RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-9456
Practice Address - Country:US
Practice Address - Phone:502-229-4842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist