Provider Demographics
NPI:1265689269
Name:STEVENS, HOLLY JACOBS
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:JACOBS
Last Name:STEVENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E RIVER RD APT H95
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5762
Mailing Address - Country:US
Mailing Address - Phone:623-910-4044
Mailing Address - Fax:
Practice Address - Street 1:350 W SAHUARITA RD
Practice Address - Street 2:
Practice Address - City:SAHUARITA
Practice Address - State:AZ
Practice Address - Zip Code:85629-9000
Practice Address - Country:US
Practice Address - Phone:520-625-3502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPL5955235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist