Provider Demographics
NPI:1740435429
Name:HILLIKER, KELLY A (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:HILLIKER
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 1:1234 JOANNE TER
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:IL
Mailing Address - Zip Code:61010-9717
Mailing Address - Country:US
Mailing Address - Phone:815-986-6607
Mailing Address - Fax:
Practice Address - Street 1:1234 JOANNE TER
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:IL
Practice Address - Zip Code:61010-9717
Practice Address - Country:US
Practice Address - Phone:815-986-6607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-23
Last Update Date:2008-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.008674235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist