Provider Demographics
NPI:1114356367
Name:HOLLEY, JENNY (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:HOLLEY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5871 GROVELAND STATION RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT MORRIS
Mailing Address - State:NY
Mailing Address - Zip Code:14510-9767
Mailing Address - Country:US
Mailing Address - Phone:585-658-4023
Mailing Address - Fax:
Practice Address - Street 1:5871 GROVELAND STATION RD
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:NY
Practice Address - Zip Code:14510-9767
Practice Address - Country:US
Practice Address - Phone:585-658-4023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023360235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist