Provider Demographics
NPI:1265883870
Name:SUMRALL, HOLLY (MS CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:
Last Name:SUMRALL
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W BELT LINE RD
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-6015
Mailing Address - Country:US
Mailing Address - Phone:469-732-0839
Mailing Address - Fax:
Practice Address - Street 1:701 W BELT LINE RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-6015
Practice Address - Country:US
Practice Address - Phone:469-732-0839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-24
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112239235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist