Provider Demographics
NPI:1790410413
Name:HOLLABAUGH, JOY DIANNE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:DIANNE
Last Name:HOLLABAUGH
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 1:2393 SW IVORY RD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2185
Mailing Address - Country:US
Mailing Address - Phone:772-579-8827
Mailing Address - Fax:
Practice Address - Street 1:2393 SW IVORY RD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-2185
Practice Address - Country:US
Practice Address - Phone:772-579-8827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA16443235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist