Provider Demographics
NPI:1053682013
Name:GOMBS, HOLLY E (MA CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:E
Last Name:GOMBS
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:MS
Other - First Name:HOLLY
Other - Middle Name:E
Other - Last Name:GUNTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15668 CARINA DRIVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828
Mailing Address - Country:US
Mailing Address - Phone:954-242-1808
Mailing Address - Fax:
Practice Address - Street 1:15668 CARINA DRIVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828
Practice Address - Country:US
Practice Address - Phone:954-242-1808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA1189235Z00000X
FLSZ 5709235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist