MEDICARE: MRS. COLLEEN MARIE HOLLE M.S. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP-2156	ID
2	235Z00000X	Speech-Language Pathologist	SLP-5343	ID

General Provider Information

NPI Number	:	1225301195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. COLLEEN MARIE HOLLE M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	PO BOX 596
Second Line	:
City	:	GOODING
State	:	ID
Zip	:	83330
Country	:	US
Telephone Number	:	208-725-3680
Fax Number	:	208-595-2276

Provider Business Practice Location Address
First Line	:	733 N. MAIN STREET
Second Line	:	SUITE G
City	:	BELLEVUE
State	:	ID
Zip	:	83313
Country	:	US
Telephone Number	:	208-725-3680
Fax Number	:	208-595-2276

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2012
Last Update Date	:	08/26/2022

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Directions to “ MRS. COLLEEN MARIE HOLLE M.S. CCC-SLP” Practice Location

Language	Start Address	Practice Location

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