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General NPI Number Information
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NPI Number | 1215296983
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Entity Type | Individual
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Provider Name | JENNIFER LYNN HOLLORAN
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Gender | Female
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Dates
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Enumeration Date | 05/15/2012
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Last Update Date | 05/15/2012
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Provider Practice Location Address
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Address Line | 8317 FRONT BEACH ROAD SUITE 34C
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32407
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Country | US
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Telephone | 850-233-3984
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Fax |
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Provider Business Mailing Address
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Address Line | 105 HOWARD COURT
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City | PANAMA CITY
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State | FL
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Zip | 32404
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Country | US
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Telephone | 850-867-0503
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA11258
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License Number State | FL
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