Basic Information
Provider Information
NPI: 1356677231
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DI RIE
FirstName: HOLLY
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: SLP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 VERNEY DR
Address2:  
City: GREENFIELD
State: NH
PostalCode: 030475000
CountryCode: US
TelephoneNumber: 6035473311
FaxNumber: 6035473232
Practice Location
Address1: 1 VERNEY DR
Address2:  
City: GREENFIELD
State: NH
PostalCode: 030475000
CountryCode: US
TelephoneNumber: 6035473311
FaxNumber: 6035473232
Other Information
ProviderEnumerationDate: 10/27/2009
LastUpdateDate: 10/27/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X1137NHY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


Home