Provider Demographics
NPI:1629714738
Name:PAVLICEK, HOLLY
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:PAVLICEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 MEDICAL DR STE 1
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-3114
Mailing Address - Country:US
Mailing Address - Phone:361-573-4832
Mailing Address - Fax:361-575-6244
Practice Address - Street 1:117 MEDICAL DR STE 1
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-3114
Practice Address - Country:US
Practice Address - Phone:361-573-4832
Practice Address - Fax:361-575-6244
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81350231H00000X
231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist