Healthcare Provider Details

I. General information

NPI: 1194657973
Provider Name (Legal Business Name): HOLLY DANIELLE CULLEN M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 MURRAY DR
EL CAJON CA
92020-5664
US

IV. Provider business mailing address

2557 COLUMBINE DR
ALPINE CA
91901-1305
US

V. Phone/Fax

Practice location:
  • Phone: 619-660-3187
  • Fax:
Mailing address:
  • Phone: 760-522-6250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number32214
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: