Provider Demographics
NPI:1326291287
Name:HOLCOMB BERRY, J TALESE (MSCCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:J TALESE
Middle Name:
Last Name:HOLCOMB BERRY
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 CHAVIES RD
Mailing Address - Street 2:
Mailing Address - City:RAINSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35986-4659
Mailing Address - Country:US
Mailing Address - Phone:256-506-0281
Mailing Address - Fax:
Practice Address - Street 1:1531 S BROAD ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-2647
Practice Address - Country:US
Practice Address - Phone:256-259-4433
Practice Address - Fax:256-259-4435
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1888235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist