Provider Demographics
NPI:1972857373
Name:PERDULOVSKI, HOLLY ANDERSON (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANDERSON
Last Name:PERDULOVSKI
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 1:6453 PORTAGE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-2248
Mailing Address - Country:US
Mailing Address - Phone:219-617-7602
Mailing Address - Fax:219-354-4440
Practice Address - Street 1:110 BEVERLY DR
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-9368
Practice Address - Country:US
Practice Address - Phone:219-926-8387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003007A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist