Provider Demographics
NPI:1629805031
Name:HILDINGER, JOHANNA VIVIAN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:VIVIAN
Last Name:HILDINGER
Suffix:
Gender:F
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 1:2011 S GRANT ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-3811
Mailing Address - Country:US
Mailing Address - Phone:989-450-4608
Mailing Address - Fax:
Practice Address - Street 1:2011 S GRANT ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-3811
Practice Address - Country:US
Practice Address - Phone:989-450-4608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101004581235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist