Provider Demographics
NPI:1477151785
Name:PRZYBYLOWSKI, HOLLY NICOLE (SLP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:NICOLE
Last Name:PRZYBYLOWSKI
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:PO BOX 1739
Mailing Address - Street 2:
Mailing Address - City:HAYFORK
Mailing Address - State:CA
Mailing Address - Zip Code:96041-1739
Mailing Address - Country:US
Mailing Address - Phone:267-614-9709
Mailing Address - Fax:
Practice Address - Street 1:480 OLD HAYWAGON RD
Practice Address - Street 2:
Practice Address - City:HAYFORK
Practice Address - State:CA
Practice Address - Zip Code:96041-9604
Practice Address - Country:US
Practice Address - Phone:267-614-9709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26348235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist