Provider Demographics
NPI:1669883302
Name:CHRISTINA, HOLLY (CCC-SLP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:CHRISTINA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 TOWN BANK RD
Mailing Address - Street 2:
Mailing Address - City:N CAPE MAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08204-3527
Mailing Address - Country:US
Mailing Address - Phone:407-432-2382
Mailing Address - Fax:
Practice Address - Street 1:627 TOWN BANK RD
Practice Address - Street 2:
Practice Address - City:N CAPE MAY
Practice Address - State:NJ
Practice Address - Zip Code:08204-3527
Practice Address - Country:US
Practice Address - Phone:407-432-2382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00758300235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist