MEDICARE: HOLLY PATRICK MS, 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	101232	TX

General Provider Information

NPI Number	:	1558750463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY PATRICK MS, CCC-SLP

Provider Business Mailing Address
First Line	:	1271 MOSSY HOLW
Second Line	:
City	:	SPRING BRANCH
State	:	TX
Zip	:	78070-6067
Country	:	US
Telephone Number	:	214-669-3399
Fax Number	:

Provider Business Practice Location Address
First Line	:	1271 MOSSY HOLW
Second Line	:
City	:	SPRING BRANCH
State	:	TX
Zip	:	78070-6067
Country	:	US
Telephone Number	:	214-669-3399
Fax Number	:

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

Provider Enumeration Date	:	01/15/2015
Last Update Date	:	01/15/2015

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