Basic Information
| Provider Information | |||||||||
| NPI: | 1598768582 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLLAR | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | RUTH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | AU.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 MARYS AVE | ||||||||
| Address2: | DEPT OF AUDIOLOGY | ||||||||
| City: | KINGSTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 124015848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453343121 | ||||||||
| FaxNumber: | 8453344789 | ||||||||
| Practice Location | |||||||||
| Address1: | 105 MARYS AVE | ||||||||
| Address2: | DEPARTMENT OF AUDIOLOGY | ||||||||
| City: | KINGSTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 124015848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453343121 | ||||||||
| FaxNumber: | 8453344789 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2005 | ||||||||
| LastUpdateDate: | 10/05/2009 | ||||||||
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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 | 231H00000X | 000949 | NY | Y | Speech, Language and Hearing Service Providers | Audiologist | 237600000X | 140000021026 | NY | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.