Active NPI
Holly L Harris, M.A. CCC-SLP
- Speech-Language Pathologist
- Staten Island, NY
National Provider Identifier
1255683397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 41YS00725100
- Practice address
- 177 Edgegrove Ave
Staten Island, NY 10312-3332 - Phone
- (718) 608-4307
- NPI assigned
- Oct 14, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 41YS00725100 | NJ | Primary |
Addresses
Primary practice location
177 Edgegrove Ave
Staten Island, NY 10312-3332
Mailing address
49 Canfield LN
Aberdeen, NJ 07747-2204
Phone (718) 608-4307
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 41YS00725100 | NJ | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350172800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727654400000",
"number": "1255683397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "49 CANFIELD LN",
"city": "ABERDEEN",
"state": "NJ",
"postal_code": "077472204",
"telephone_number": "718-608-4307"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "177 EDGEGROVE AVE",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103123332",
"telephone_number": "718-608-4307"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRIS",
"first_name": "HOLLY",
"middle_name": "L",
"name_prefix": "Mrs.",
"credential": "M.A. CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-10-14",
"last_updated": "2024-09-30",
"certification_date": "2024-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NJ",
"license": "41YS00725100",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Staten Island, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.