Provider Demographics
NPI:1356341291
Name:HILLARD, MICHELE L (CCC-A)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:L
Last Name:HILLARD
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:PO BOX 73
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-0004
Mailing Address - Country:US
Mailing Address - Phone:425-391-3343
Mailing Address - Fax:425-391-5692
Practice Address - Street 1:49 FRONT ST N
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-3237
Practice Address - Country:US
Practice Address - Phone:425-391-3343
Practice Address - Fax:425-391-5692
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
231H00000X, 237600000X
WALD00001725231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAHI3565OtherREGENCE BLUE SHIELD
WA131372OtherLABOR & INDUSTRIES
WAAB11852Medicare ID - Type Unspecified