Provider Demographics
NPI:1467733170
Name:MARSHALL, HOLLY BETH (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:BETH
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:BETH
Other - Last Name:MENESES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:1 HEAD START CIR
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-5238
Mailing Address - Country:US
Mailing Address - Phone:845-352-6671
Mailing Address - Fax:
Practice Address - Street 1:1 HEAD START CIR
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-5238
Practice Address - Country:US
Practice Address - Phone:845-352-6671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist