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General NPI Number Information
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NPI Number | 1265850481
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Entity Type | Organization
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Legal Business Name | HOLLY CREEK STAR CENTER, INC.
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Dates
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Enumeration Date | 04/03/2014
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Last Update Date | 04/03/2014
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Provider Practice Location Address
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Address Line | 3680 DELLWOOD RD
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City | LOXAHATCHEE
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State | FL
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Zip | 33470-2445
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Country | US
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Telephone | 561-899-3448
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Fax | 561-899-3448
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Provider Business Mailing Address
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Address Line | 3680 DELLWOOD RD
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City | LOXAHATCHEE
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State | FL
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Zip | 33470-2445
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Country | US
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Telephone | 561-899-3448
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Fax | 561-899-3448
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Authorized Official
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Title or Position | OWNER
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Name | CAROLE DENISE WALKER
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Credential | MS, CCC-SLP
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Telephone | 561-383-1850
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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 | SA11907
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License Number State | FL
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