Provider Demographics
NPI:1053070540
Name:HOLLENBAUGH, MARY ADELE (MSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ADELE
Last Name:HOLLENBAUGH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 N MAIN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-6115
Mailing Address - Country:US
Mailing Address - Phone:801-298-5222
Mailing Address - Fax:
Practice Address - Street 1:70 N MAIN ST STE 104
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6115
Practice Address - Country:US
Practice Address - Phone:801-298-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-11
Last Update Date:2021-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program