Healthcare Provider Details

I. General information

NPI: 1295117513
Provider Name (Legal Business Name): HOLLY DOW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOLLY DOW

II. Dates (important events)

Enumeration Date: 06/23/2015
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 SCHOENHAAR DR
WEST BEND WI
53090-2649
US

IV. Provider business mailing address

620 SCHOENHAAR DR
WEST BEND WI
53090-2649
US

V. Phone/Fax

Practice location:
  • Phone: 262-306-8450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4137-154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: