Individual
HOLLIS PASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
24335 REGINA ST, MISSION VIEJO, CA 92691-4714
(949) 433-1003
(949) 916-0155
Mailing address
24335 REGINA ST, MISSION VIEJO, CA 92691-4714
(949) 433-1003
(949) 916-0155
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
19668
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19668
SLP
CA
Enumeration date
08/04/2014
Last updated
01/23/2019
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