Provider Demographics
NPI:1225301195
Name:HOLLE, COLLEEN MARIE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:MARIE
Last Name:HOLLE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:MARIE
Other - Last Name:MAURO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:PO BOX 596
Mailing Address - Street 2:
Mailing Address - City:GOODING
Mailing Address - State:ID
Mailing Address - Zip Code:83330
Mailing Address - Country:US
Mailing Address - Phone:208-725-3680
Mailing Address - Fax:208-595-2276
Practice Address - Street 1:733 N. MAIN STREET
Practice Address - Street 2:SUITE G
Practice Address - City:BELLEVUE
Practice Address - State:ID
Practice Address - Zip Code:83313
Practice Address - Country:US
Practice Address - Phone:208-725-3680
Practice Address - Fax:208-595-2276
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-2156235Z00000X
IDSLP-5343235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist