Provider Demographics
NPI:1669871661
Name:DICKEN, HOLLY CHRISTINE
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:CHRISTINE
Last Name:DICKEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:HOLLY
Other - Middle Name:CHRISTINE
Other - Last Name:KENNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14417 AMCELLE ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-5681
Mailing Address - Country:US
Mailing Address - Phone:301-331-4033
Mailing Address - Fax:
Practice Address - Street 1:1 DIANE DRIVE
Practice Address - Street 2:
Practice Address - City:FORT ASHBY
Practice Address - State:WV
Practice Address - Zip Code:26719
Practice Address - Country:US
Practice Address - Phone:304-298-3602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVP/SLP-0609235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist