Provider Demographics
NPI:1235549528
Name:JARVIS, HOLLY KATHERINE (LAC)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:KATHERINE
Last Name:JARVIS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5111 ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-2047
Mailing Address - Country:US
Mailing Address - Phone:479-595-0333
Mailing Address - Fax:
Practice Address - Street 1:5111 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-2047
Practice Address - Country:US
Practice Address - Phone:479-595-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR#14-0082355S0801X
ARA2206017101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARR#14-008OtherARKANSAS BOARD OF SPEECH PATHOLOGISTS AND AUDIOLOGISTS REGISTRATION