Provider Demographics
NPI:1174096457
Name:HOLDER, EMMA (MS, CCC/SLP)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:HOLDER
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 GREENVILLE AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-5036
Mailing Address - Country:US
Mailing Address - Phone:972-757-7304
Mailing Address - Fax:
Practice Address - Street 1:4600 GREENVILLE AVE STE 160
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-5036
Practice Address - Country:US
Practice Address - Phone:214-457-0588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115263235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist