Provider Demographics
NPI:1417359563
Name:FERNALLD, HOLLY LEANNE
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:LEANNE
Last Name:FERNALLD
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 1:327 W IVANHOE RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-2167
Mailing Address - Country:US
Mailing Address - Phone:509-466-7951
Mailing Address - Fax:
Practice Address - Street 1:906 W WEILE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-6263
Practice Address - Country:US
Practice Address - Phone:509-354-3382
Practice Address - Fax:509-354-3404
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60576946235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALL605769946OtherDOH