Provider Demographics
NPI:1114239803
Name:HIEB, HOLLIE JO (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:HOLLIE
Middle Name:JO
Last Name:HIEB
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:HOLLIE
Other - Middle Name:JO
Other - Last Name:BOWMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:1521 DIXON TRL
Mailing Address - Street 2:
Mailing Address - City:KIMBERLY
Mailing Address - State:ID
Mailing Address - Zip Code:83341-4903
Mailing Address - Country:US
Mailing Address - Phone:208-749-0140
Mailing Address - Fax:
Practice Address - Street 1:1521 DIXON TRL
Practice Address - Street 2:
Practice Address - City:KIMBERLY
Practice Address - State:ID
Practice Address - Zip Code:83341-4903
Practice Address - Country:US
Practice Address - Phone:208-749-0140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-09
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-1893235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist