Basic Information
| Provider Information | |||||||||
| NPI: | 1972857373 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PERDULOVSKI | ||||||||
| FirstName: | HOLLY | ||||||||
| MiddleName: | ANDERSON | ||||||||
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| Credential: | MS CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6453 PORTAGE AVE | ||||||||
| Address2: | |||||||||
| City: | PORTAGE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463682248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2196177602 | ||||||||
| FaxNumber: | 2193544440 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 BEVERLY DR | ||||||||
| Address2: | |||||||||
| City: | CHESTERTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463049368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2199268387 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2012 | ||||||||
| LastUpdateDate: | 11/07/2012 | ||||||||
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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 | 22003007A | IN | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.