Provider Demographics
NPI:1609583657
Name:FULLEST EXPRESSIONS SPEECH THERAPY, PLLC
Entity Type:Organization
Organization Name:FULLEST EXPRESSIONS SPEECH THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOLLENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:616-550-4450
Mailing Address - Street 1:10650 SAPPHIRE TRL
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-7644
Mailing Address - Country:US
Mailing Address - Phone:616-550-4450
Mailing Address - Fax:
Practice Address - Street 1:10650 SAPPHIRE TRL
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-7644
Practice Address - Country:US
Practice Address - Phone:616-550-4450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty