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NPI Code Detail

MEDICARE: HOLLE AHNA MARICLE M.A., CCC-SLP

MEDICARE: HOLLE AHNA MARICLE M.A., 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
1235Z00000XSpeech-Language Pathologist01491IA

General Provider Information

NPI Number : 1265869713
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOLLE AHNA MARICLE M.A., CCC-SLP
Provider Business Mailing Address
First Line : 700 WAVERLY RD
Second Line :
City : DAVENPORT
State : IA
Zip : 52804-4317
Country : US
Telephone Number : 563-324-1651
Fax Number :
Provider Business Practice Location Address
First Line : 700 WAVERLY RD
Second Line :
City : DAVENPORT
State : IA
Zip : 52804-4317
Country : US
Telephone Number : 563-324-1651
Fax Number : 563-324-1651
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2013
Last Update Date : 09/30/2013

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Directions to “ HOLLE AHNA MARICLE M.A., CCC-SLP” Practice Location

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