Provider Demographics
NPI:1326778960
Name:HOLLEMBAEK, MEGAN HOLLY
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:HOLLY
Last Name:HOLLEMBAEK
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 1:1551 ATRIA CIR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-5327
Mailing Address - Country:US
Mailing Address - Phone:843-446-0743
Mailing Address - Fax:
Practice Address - Street 1:1330 SAINT MARYS ST STE 340
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-3334
Practice Address - Country:US
Practice Address - Phone:843-446-0743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZCS21454197Medicaid