MEDICARE: MRS. HOLLI TERESA HORLACHER

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	41YS00604200	NJ

General Provider Information

NPI Number	:	1407320773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HOLLI TERESA HORLACHER

Provider Business Mailing Address
First Line	:	899 MOUNTAIN AVE STE 1A
Second Line	:
City	:	SPRINGFIELD
State	:	NJ
Zip	:	07081-3403
Country	:	US
Telephone Number	:	973-218-6394
Fax Number	:

Provider Business Practice Location Address
First Line	:	899 MOUNTAIN AVE STE 1A
Second Line	:
City	:	SPRINGFIELD
State	:	NJ
Zip	:	07081-3403
Country	:	US
Telephone Number	:	973-218-6394
Fax Number	:

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

Provider Enumeration Date	:	01/18/2019
Last Update Date	:	01/18/2019

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Directions to “ MRS. HOLLI TERESA HORLACHER ” Practice Location

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