Provider Demographics
NPI:1639696602
Name:DONOVAN, HOLLY (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:DONOVAN
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 1:648 WOODVALLEY DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-2135
Mailing Address - Country:US
Mailing Address - Phone:727-656-0660
Mailing Address - Fax:
Practice Address - Street 1:3390 SAXONBURG BLVD STE 250
Practice Address - Street 2:
Practice Address - City:GLENSHAW
Practice Address - State:PA
Practice Address - Zip Code:15116-3160
Practice Address - Country:US
Practice Address - Phone:412-767-5967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-29
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL014238235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSZ8222OtherFL DEPARTMENT OF HEALTH - BOARD OF SPEECH-LANGUAGE PATHOLOGY
PASL014238OtherCOMMONWEALTH OF PA - BUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS