Provider Demographics
NPI:1003691841
Name:HOLLO, ROSEANNA LEAH (BCND)
Entity Type:Individual
Prefix:
First Name:ROSEANNA
Middle Name:LEAH
Last Name:HOLLO
Suffix:
Gender:F
Credentials:BCND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 WESTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-1433
Mailing Address - Country:US
Mailing Address - Phone:419-239-6653
Mailing Address - Fax:
Practice Address - Street 1:105 WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-1433
Practice Address - Country:US
Practice Address - Phone:419-239-2113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X
LALEHP717374K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
No171400000XOther Service ProvidersHealth & Wellness Coach