Provider Demographics
NPI:1326778960
Name:HOLLEMBAEK, MEGAN HOLLY
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:HOLLY
Last Name:HOLLEMBAEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4840 W GILL PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80219-2233
Mailing Address - Country:US
Mailing Address - Phone:843-446-0743
Mailing Address - Fax:
Practice Address - Street 1:2979 UINTA ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-3959
Practice Address - Country:US
Practice Address - Phone:843-446-0743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZCS21454197Medicaid