Provider Demographics
NPI:1033368188
Name:SWANSON, HOLLY ANN (SLP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANN
Last Name:SWANSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10011 SW 77TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2651
Mailing Address - Country:US
Mailing Address - Phone:305-663-7732
Mailing Address - Fax:305-228-6251
Practice Address - Street 1:4284 SW 161ST PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-3826
Practice Address - Country:US
Practice Address - Phone:305-228-6252
Practice Address - Fax:305-228-6251
Is Sole Proprietor?:No
Enumeration Date:2008-09-13
Last Update Date:2008-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9578235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist