MEDICARE: HILLARY SHAW M.S., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	14191597-4104	UT

General Provider Information

NPI Number	:	1104640390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HILLARY SHAW M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	2714 S YUMA ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-1715
Country	:	US
Telephone Number	:	801-710-6103
Fax Number	:

Provider Business Practice Location Address
First Line	:	2714 S YUMA ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-1715
Country	:	US
Telephone Number	:	801-710-6103
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2024
Last Update Date	:	05/13/2026

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