Provider Demographics
NPI:1265793806
Name:GARCIA, HOLLY (AUD)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 WASHINGTON AVE S
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8015 SHOAL CREEK BLVD STE 122
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-8052
Practice Address - Country:US
Practice Address - Phone:512-450-1492
Practice Address - Fax:512-302-5810
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7094231H00000X
CA3259231H00000X
CO0000808231H00000X
NC11978231H00000X
TX80489231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80792AOtherBCBS-AENTC
TX80793AOtherBCBS-HCAENC
TX80793AOtherBCBS-HCAENC
TXTXB154158Medicare PIN