Provider Demographics
NPI:1134699051
Name:HOLLY, SANDRA LYNN (MS, SLP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LYNN
Last Name:HOLLY
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:LYNN
Other - Last Name:FOHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, SLP
Mailing Address - Street 1:100 THOMAS RUN RD
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-1600
Mailing Address - Country:US
Mailing Address - Phone:410-638-3810
Mailing Address - Fax:
Practice Address - Street 1:100 THOMAS RUN RD
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-1600
Practice Address - Country:US
Practice Address - Phone:443-638-3810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07445235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist