MEDICARE: MARIANA HOLMBOE

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	SLP.0001232	CO

General Provider Information

NPI Number	:	1942804653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIANA HOLMBOE

Provider Business Mailing Address
First Line	:	799 MILWAUKEE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-3901
Country	:	US
Telephone Number	:	802-734-9196
Fax Number	:

Provider Business Practice Location Address
First Line	:	799 MILWAUKEE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-3901
Country	:	US
Telephone Number	:	802-734-9196
Fax Number	:

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

Provider Enumeration Date	:	11/23/2020
Last Update Date	:	11/23/2020

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Directions to “ MARIANA HOLMBOE ” Practice Location

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