Provider Demographics
NPI:1821868100
Name:HOLLISTER, AIMEE
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:
Last Name:HOLLISTER
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 1:12 SUNNYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-5119
Mailing Address - Country:US
Mailing Address - Phone:860-997-9314
Mailing Address - Fax:
Practice Address - Street 1:12 SUNNYVIEW DR
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-5119
Practice Address - Country:US
Practice Address - Phone:860-997-9314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician