Provider Demographics
NPI:1083886428
Name:HOLMES, JENNY (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5816 W OAKCREST DR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57107-0997
Mailing Address - Country:US
Mailing Address - Phone:605-530-5816
Mailing Address - Fax:
Practice Address - Street 1:5816 W OAKCREST DR
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57107-0997
Practice Address - Country:US
Practice Address - Phone:605-530-5816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist