Provider Demographics
NPI:1457480899
Name:GEESLIN, HOLLY (CCC-A, CCC-SLP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:GEESLIN
Suffix:
Gender:F
Credentials:CCC-A, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7436 N RITTER AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2648
Mailing Address - Country:US
Mailing Address - Phone:317-577-9953
Mailing Address - Fax:
Practice Address - Street 1:7436 N RITTER AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2648
Practice Address - Country:US
Practice Address - Phone:317-577-9953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23001997A231H00000X
IN22003500A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist