Provider Demographics
NPI:1366641516
Name:HOLLAND, CAROLYN ALLEN (SLP)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:ALLEN
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7597 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COOPERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18036-2460
Mailing Address - Country:US
Mailing Address - Phone:610-282-1919
Mailing Address - Fax:610-282-6157
Practice Address - Street 1:7650 ROUTE 309
Practice Address - Street 2:
Practice Address - City:COOPERSBURG
Practice Address - State:PA
Practice Address - Zip Code:18036-2130
Practice Address - Country:US
Practice Address - Phone:610-282-1919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL000790L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist