Provider Demographics
NPI:1215288840
Name:HOLLY, DIANNE LINDA (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:LINDA
Last Name:HOLLY
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 1:6900 WOODY TRL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-1852
Mailing Address - Country:US
Mailing Address - Phone:213-842-0276
Mailing Address - Fax:323-874-8065
Practice Address - Street 1:6900 WOODY TRL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-1852
Practice Address - Country:US
Practice Address - Phone:323-874-8065
Practice Address - Fax:323-874-8065
Is Sole Proprietor?:No
Enumeration Date:2012-09-21
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16024235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist