Provider Demographics
NPI:1134263692
Name:ALTMAN, HOLLIS (MA CCC-A)
Entity type:Individual
Prefix:
First Name:HOLLIS
Middle Name:
Last Name:ALTMAN
Suffix:
Gender:F
Credentials:MA CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 ROUND HILL RD
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2123
Mailing Address - Country:US
Mailing Address - Phone:413-582-1114
Mailing Address - Fax:
Practice Address - Street 1:45 ROUND HILL RD
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2123
Practice Address - Country:US
Practice Address - Phone:413-582-1114
Practice Address - Fax:413-587-9737
Is Sole Proprietor?:No
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7-W231HA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5104092Medicaid
MAAL031764Medicare ID - Type Unspecified