Provider Demographics
NPI:1174706584
Name:ESTABROOK, HOLLY MARIE (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:MARIE
Last Name:ESTABROOK
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:MARIE
Other - Last Name:DOYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:516 W BIJOU ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-1311
Mailing Address - Country:US
Mailing Address - Phone:719-633-9114
Mailing Address - Fax:719-329-0495
Practice Address - Street 1:516 W BIJOU ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-1311
Practice Address - Country:US
Practice Address - Phone:719-633-9114
Practice Address - Fax:719-329-0495
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO98785028Medicaid