Provider Demographics
NPI:1417131921
Name:RICHARD, HOLLY J (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:J
Last Name:RICHARD
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 1:75 TEMI RD
Mailing Address - Street 2:
Mailing Address - City:RAYNHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02767-1220
Mailing Address - Country:US
Mailing Address - Phone:774-930-1998
Mailing Address - Fax:
Practice Address - Street 1:75 TEMI RD
Practice Address - Street 2:
Practice Address - City:RAYNHAM
Practice Address - State:MA
Practice Address - Zip Code:02767-1220
Practice Address - Country:US
Practice Address - Phone:774-930-1998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6618235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist