Healthcare Provider Details

I. General information

NPI: 1770415754
Provider Name (Legal Business Name): HOLLY L. CHARPENTIER CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3036 THOMPSON AVE
SELMA CA
93662-2433
US

IV. Provider business mailing address

2865 17TH AVE
KINGSBURG CA
93631-3102
US

V. Phone/Fax

Practice location:
  • Phone: 559-898-6500
  • Fax:
Mailing address:
  • Phone: 559-967-3962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number8820
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: