Active NPI
Holly Dyan Gustavson, MA CCC-SLP
- Speech-Language Pathologist
- Oxnard, CA
National Provider Identifier
1922268721
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 15235
- Practice address
- 2641 S C St
Oxnard, CA 93033-4502 - Phone
- (805) 487-7840
- NPI assigned
- Jun 15, 2008
- Last updated
- Jun 15, 2008
- 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 | 15235 | CA | Primary |
Addresses
Primary practice location
2641 S C St
Oxnard, CA 93033-4502
Mailing address
1062 Guam Dr Apt B
Port Hueneme, CA 93041-3918
Phone (832) 969-7040
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1213488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213488000000",
"number": "1922268721",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1062 GUAM DR APT B",
"city": "PORT HUENEME",
"state": "CA",
"postal_code": "930413918",
"telephone_number": "832-969-7040"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2641 S C ST",
"city": "OXNARD",
"state": "CA",
"postal_code": "930334502",
"telephone_number": "805-487-7840"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUSTAVSON",
"first_name": "HOLLY",
"middle_name": "DYAN",
"credential": "MA CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-06-15",
"last_updated": "2008-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "15235",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oxnard, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.