Provider Demographics
NPI:1083780639
Name:MARSHALL, HOLLY CHRISTA (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:CHRISTA
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9550 S 95TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6163
Mailing Address - Country:US
Mailing Address - Phone:918-850-5148
Mailing Address - Fax:918-494-0927
Practice Address - Street 1:9550 S 95TH EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6163
Practice Address - Country:US
Practice Address - Phone:918-850-5148
Practice Address - Fax:918-494-0927
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3087235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200062070Medicaid