Provider Demographics
NPI:1023200482
Name:STEVENS, HOLLY E (CCC-SLP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:E
Last Name:STEVENS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 WAVERLY AVE
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-1213
Mailing Address - Country:US
Mailing Address - Phone:330-317-9521
Mailing Address - Fax:
Practice Address - Street 1:243 WAVERLY AVE
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-1213
Practice Address - Country:US
Practice Address - Phone:330-317-9521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.12317235Z00000X
NC7699235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist