Provider Demographics
NPI:1427457308
Name:HILLIARD, SHIRAH (MSP,CCC/SLP)
Entity type:Individual
Prefix:
First Name:SHIRAH
Middle Name:
Last Name:HILLIARD
Suffix:
Gender:F
Credentials:MSP,CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1483 BELMAR DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-1778
Mailing Address - Country:US
Mailing Address - Phone:803-606-7844
Mailing Address - Fax:
Practice Address - Street 1:2125 CRITTENDEN DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1911
Practice Address - Country:US
Practice Address - Phone:803-606-7844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4128235Z00000X
SC5567235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist