Healthcare Provider Details

I. General information

NPI: 1720657695
Provider Name (Legal Business Name): STEPHANIE ERIN HILLIARD M.A. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 06/23/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 E FLORIDA AVE STE 917
DENVER CO
80210-2549
US

IV. Provider business mailing address

2027 SUNRIDGE CIR
BROOMFIELD CO
80020-6745
US

V. Phone/Fax

Practice location:
  • Phone: 844-757-7450
  • Fax:
Mailing address:
  • Phone: 724-513-0763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number0004467
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: