Provider Demographics
NPI:1275965741
Name:QUALLS, HOLLY HEATH (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:HEATH
Last Name:QUALLS
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:PO BOX 1733
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NV
Mailing Address - Zip Code:89415-1733
Mailing Address - Country:US
Mailing Address - Phone:775-316-0289
Mailing Address - Fax:
Practice Address - Street 1:317 D STREET
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NV
Practice Address - Zip Code:89415
Practice Address - Country:US
Practice Address - Phone:775-316-0289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-281235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist