Provider Demographics
NPI:1740068378
Name:KINGEN, HOLLY (CF-SLP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:KINGEN
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 MONTEREY OAKS BLVD APT 1435
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-0925
Mailing Address - Country:US
Mailing Address - Phone:985-232-9313
Mailing Address - Fax:
Practice Address - Street 1:4701 MONTEREY OAKS BLVD APT 1435
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-0925
Practice Address - Country:US
Practice Address - Phone:985-232-9313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121801235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist