Provider Demographics
NPI:1104167733
Name:WILES, HOLLY (AUD, CCC-A)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:WILES
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14761 ORCHARD PKWY UNIT 202
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80023-9114
Mailing Address - Country:US
Mailing Address - Phone:617-459-5049
Mailing Address - Fax:303-456-8924
Practice Address - Street 1:7850 VANCE DR
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-2118
Practice Address - Country:US
Practice Address - Phone:303-431-8881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAUD.0000663231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist