Provider Demographics
NPI:1669916425
Name:HOLLOP, STEPHANIE LYNN (AUD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNN
Last Name:HOLLOP
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LYNN
Other - Last Name:FISCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:489 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05405-1709
Mailing Address - Country:US
Mailing Address - Phone:802-656-3861
Mailing Address - Fax:802-656-2528
Practice Address - Street 1:489 MAIN ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05405
Practice Address - Country:US
Practice Address - Phone:802-656-3861
Practice Address - Fax:802-656-2528
Is Sole Proprietor?:No
Enumeration Date:2016-12-14
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002704231H00000X
VT145.0124534231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00314998Medicaid
NY00330191Medicare PIN