Provider Demographics
NPI:1225232929
Name:CARDINAL, HOLLY WORLEY (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:WORLEY
Last Name:CARDINAL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 W GRAYTHORN PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-9239
Mailing Address - Country:US
Mailing Address - Phone:520-400-9037
Mailing Address - Fax:520-544-3043
Practice Address - Street 1:1070 W GRAYTHORN PL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85737-9239
Practice Address - Country:US
Practice Address - Phone:520-400-9037
Practice Address - Fax:520-544-3043
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP1499235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ549339OtherAHCCS NUMBER