Provider Demographics
NPI:1275559841
Name:SEGEL, HOLLY A (MA/CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:A
Last Name:SEGEL
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 1:10496 E PINEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80111-5472
Mailing Address - Country:US
Mailing Address - Phone:303-694-8872
Mailing Address - Fax:720-489-3874
Practice Address - Street 1:10496 E PINEWOOD AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80111-5472
Practice Address - Country:US
Practice Address - Phone:303-694-8872
Practice Address - Fax:720-489-3874
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2011-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10898235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07809072Medicaid