Provider Demographics
NPI:1861971293
Name:BRAGAN, HOLLY JANE (SLP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:JANE
Last Name:BRAGAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:797 WILSON ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1003
Mailing Address - Country:US
Mailing Address - Phone:207-947-8493
Mailing Address - Fax:207-990-4817
Practice Address - Street 1:797 WILSON ST STE 2
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1003
Practice Address - Country:US
Practice Address - Phone:207-947-8493
Practice Address - Fax:207-990-4817
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP2944235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist