Provider Demographics
NPI:1710582416
Name:COHEN, HOLLY RENEE (MACCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:RENEE
Last Name:COHEN
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:MISS
Other - First Name:HOLLY
Other - Middle Name:RENEE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MACCC-SLP
Mailing Address - Street 1:1102 SIKES AVE
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-5021
Mailing Address - Country:US
Mailing Address - Phone:573-471-2544
Mailing Address - Fax:573-471-3884
Practice Address - Street 1:1102 SIKES AVE
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-5021
Practice Address - Country:US
Practice Address - Phone:573-471-2544
Practice Address - Fax:573-471-3884
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001013752235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist