Provider Demographics
NPI:1801194428
Name:HILD, LISA M (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:HILD
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 1:1 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:PEAKS ISLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04108-1413
Mailing Address - Country:US
Mailing Address - Phone:315-420-3916
Mailing Address - Fax:
Practice Address - Street 1:1 MAPLE ST
Practice Address - Street 2:
Practice Address - City:PEAKS ISLAND
Practice Address - State:ME
Practice Address - Zip Code:04108-1413
Practice Address - Country:US
Practice Address - Phone:315-420-3916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-06
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016086235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist