Provider Demographics
NPI:1477789071
Name:HOLLERN, DEBORAH (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:HOLLERN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4621 LIGHTKEEPERS WAY
Mailing Address - Street 2:UNIT 8F
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-7999
Mailing Address - Country:US
Mailing Address - Phone:724-207-0548
Mailing Address - Fax:910-641-4152
Practice Address - Street 1:3450 JAMES B WHITE HWY S
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-8678
Practice Address - Country:US
Practice Address - Phone:910-641-4151
Practice Address - Fax:910-641-4152
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7422235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist