Healthcare Provider Details

I. General information

NPI: 1083754766
Provider Name (Legal Business Name): HOLLY MARIE GUNDERSON M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 E MAIN ST
FELTON DE
19943-4500
US

IV. Provider business mailing address

319 E MAIN ST
FELTON DE
19943-4500
US

V. Phone/Fax

Practice location:
  • Phone: 302-284-9611
  • Fax: 302-284-5820
Mailing address:
  • Phone: 302-284-9611
  • Fax: 302-284-5820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberO4-0000226
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: