Provider Demographics
NPI:1285185876
Name:HOLIEN, CAROLYN
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:
Last Name:HOLIEN
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 1:1700 11TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SOUTH DAKOTA
Mailing Address - Zip Code:57201
Mailing Address - Country:UM
Mailing Address - Phone:605-882-6370
Mailing Address - Fax:
Practice Address - Street 1:601 11TH ST NE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-1833
Practice Address - Country:US
Practice Address - Phone:605-882-6370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD467-SLP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist