Provider Demographics
NPI:1497055412
Name:COTTRELL, HOLLY CAROLYN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:CAROLYN
Last Name:COTTRELL
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 1:1240 BLALOCK RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-6447
Mailing Address - Country:US
Mailing Address - Phone:713-468-0300
Mailing Address - Fax:
Practice Address - Street 1:1240 BLALOCK RD
Practice Address - Street 2:SUITE 170
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-6443
Practice Address - Country:US
Practice Address - Phone:713-468-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18201235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX18201OtherSTATE BOARD OF EXAMINERS FOR SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY