Holly Buller

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

233554 Issued in AK

Practice address

3455 Rewak Dr Ste 103
Fairbanks, AK 99709-5024

Phone

(907) 531-6919

NPI assigned

Jan 18, 2025

Last updated

Jan 18, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1737158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737158400000",
    "number": "1346051299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1298 RICHARD BERRY DR",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997095900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3455 REWAK DR STE 103",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997095024",
            "telephone_number": "907-531-6919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLER",
        "first_name": "HOLLY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-01-18",
        "last_updated": "2025-01-18",
        "certification_date": "2025-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AK",
            "license": "233554",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Speech-Language Pathologist in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.