Provider Demographics
NPI:1083152888
Name:HOLTZ, GRACIA (SLP)
Entity Type:Individual
Prefix:
First Name:GRACIA
Middle Name:
Last Name:HOLTZ
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 1:21242 HEDGEROW TER
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5439
Mailing Address - Country:US
Mailing Address - Phone:703-687-4575
Mailing Address - Fax:
Practice Address - Street 1:21242 HEDGEROW TER
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5439
Practice Address - Country:US
Practice Address - Phone:703-687-4575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202003941235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist