Provider Demographics
NPI:1538948310
Name:BORNTRAGER, HOLLY (CCC-SLP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:BORNTRAGER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 HONEYSUCKLE CT
Mailing Address - Street 2:
Mailing Address - City:MILLBROOK
Mailing Address - State:AL
Mailing Address - Zip Code:36054-1590
Mailing Address - Country:US
Mailing Address - Phone:662-361-1577
Mailing Address - Fax:
Practice Address - Street 1:74186 TALLASSEE HWY
Practice Address - Street 2:
Practice Address - City:WETUMPKA
Practice Address - State:AL
Practice Address - Zip Code:36092-5643
Practice Address - Country:US
Practice Address - Phone:334-478-3570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5434235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist