Provider Demographics
NPI:1093148603
Name:HOLMBERG, KELLY E (MA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:E
Last Name:HOLMBERG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 NORVEL AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37216-2512
Mailing Address - Country:US
Mailing Address - Phone:859-420-1570
Mailing Address - Fax:
Practice Address - Street 1:1406 NORVEL AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37216-2512
Practice Address - Country:US
Practice Address - Phone:859-420-1570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist