Provider Demographics
NPI:1821598681
Name:DEANE, HOLLIE NIXONS
Entity Type:Individual
Prefix:MRS
First Name:HOLLIE
Middle Name:NIXONS
Last Name:DEANE
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 1:32357 DEEP MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:VA
Mailing Address - Zip Code:22508-2949
Mailing Address - Country:US
Mailing Address - Phone:540-842-2662
Mailing Address - Fax:
Practice Address - Street 1:31230 CONSTITUTION HWY
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:VA
Practice Address - Zip Code:22508-2631
Practice Address - Country:US
Practice Address - Phone:540-661-4420
Practice Address - Fax:540-661-4419
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202002003235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist