Provider Demographics
NPI:1477996312
Name:ANGSTADT, HOLLY ELIZABETH (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:ELIZABETH
Last Name:ANGSTADT
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 1:744 HILL ST SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-1904
Mailing Address - Country:US
Mailing Address - Phone:727-510-6882
Mailing Address - Fax:
Practice Address - Street 1:744 HILL ST SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-1342
Practice Address - Country:US
Practice Address - Phone:727-510-6882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 12101235Z00000X
GA14050848235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist