Provider Demographics
NPI:1386392017
Name:HUNZICKER, HOLLY (MS CC-SLP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:HUNZICKER
Suffix:
Gender:F
Credentials:MS CC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4516 S 173RD EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74134-7358
Mailing Address - Country:US
Mailing Address - Phone:918-671-7209
Mailing Address - Fax:
Practice Address - Street 1:4519 S 173RD EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74134-7357
Practice Address - Country:US
Practice Address - Phone:918-216-9303
Practice Address - Fax:539-202-5007
Is Sole Proprietor?:No
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2633235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist