Basic Information
| Provider Information | |||||||||
| NPI: | 1215384789 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANOWSKI | ||||||||
| FirstName: | HOLLY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9223 HULETT AVE | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558081446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7638437645 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16600 W SPRAGUE RD | ||||||||
| Address2: | SUITE 365 | ||||||||
| City: | MIDDLEBURG HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441306318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162277700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2016 | ||||||||
| LastUpdateDate: | 12/26/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | XZG802531563 | 01 | MN | BLUECROSS BLUESHIELD BLUEPLUS OF MINNESOTA | OTHER |