Provider Demographics
NPI:1023313228
Name:HOLLENSTEINER, GARY KENT (B C - H I S)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:KENT
Last Name:HOLLENSTEINER
Suffix:
Gender:M
Credentials:B C - H I S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-4159
Mailing Address - Country:US
Mailing Address - Phone:217-224-8855
Mailing Address - Fax:217-224-8855
Practice Address - Street 1:325 S 8TH ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-4159
Practice Address - Country:US
Practice Address - Phone:217-224-8855
Practice Address - Fax:217-224-8855
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1120237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist