Healthcare Provider Details

I. General information

NPI: 1154466779
Provider Name (Legal Business Name): MICHELLE HILTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PRESUMPSCOT ST
PORTLAND ME
04103-5225
US

IV. Provider business mailing address

156 DANFORTH ST APT 2
PORTLAND ME
04102-3865
US

V. Phone/Fax

Practice location:
  • Phone: 207-828-0754
  • Fax:
Mailing address:
  • Phone: 207-459-0393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP1542
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: