Provider Demographics
NPI:1306186200
Name:NOVER, HOLLY (MA, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:NOVER
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 1:172 CRESTHAVEN PL
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-7277
Mailing Address - Country:US
Mailing Address - Phone:904-669-8448
Mailing Address - Fax:
Practice Address - Street 1:172 CRESTHAVEN PL
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-7277
Practice Address - Country:US
Practice Address - Phone:904-669-8448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 8485235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist