Provider Demographics
NPI:1063972362
Name:HOLLIS, OLIVIA MARIE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:MARIE
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:MARIE
Other - Last Name:TENNISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:2 VILLAGE SQ STE 210
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-1624
Mailing Address - Country:US
Mailing Address - Phone:614-602-6473
Mailing Address - Fax:614-987-8643
Practice Address - Street 1:7649 NEW MARKET CENTER WAY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-1979
Practice Address - Country:US
Practice Address - Phone:614-602-6473
Practice Address - Fax:614-987-8643
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0377205Medicaid