Provider Demographics
NPI:1356677272
Name:HOWARD, HOLLY M (SLP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:M
Last Name:HOWARD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 REBIE RD
Mailing Address - Street 2:
Mailing Address - City:DUDLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31022-2411
Mailing Address - Country:US
Mailing Address - Phone:478-595-0317
Mailing Address - Fax:888-249-7172
Practice Address - Street 1:2035 REBIE RD
Practice Address - Street 2:
Practice Address - City:DUDLEY
Practice Address - State:GA
Practice Address - Zip Code:31022
Practice Address - Country:US
Practice Address - Phone:478-595-0317
Practice Address - Fax:888-249-7172
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-28
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005385235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA325494851BMedicaid
GA116544Medicare PIN