Provider Demographics
NPI:1932484672
Name:POLSON, HOLLY E (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:E
Last Name:POLSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:E
Other - Last Name:MANNSCHRECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3044 PARK LN APT A
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-9658
Mailing Address - Country:US
Mailing Address - Phone:727-455-3949
Mailing Address - Fax:
Practice Address - Street 1:3044 PARK LN APT A
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-9658
Practice Address - Country:US
Practice Address - Phone:727-455-3949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005158235Z00000X
FLSA12415235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist