Provider Demographics
NPI:1407050305
Name:BUCHHOLZ, JOANNA (MS-SLP)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:BUCHHOLZ
Suffix:
Gender:F
Credentials:MS-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:COLSTRIP
Mailing Address - State:MT
Mailing Address - Zip Code:59323-0267
Mailing Address - Country:US
Mailing Address - Phone:406-740-0446
Mailing Address - Fax:
Practice Address - Street 1:2200 BOX ELDER ST
Practice Address - Street 2:
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301-2899
Practice Address - Country:US
Practice Address - Phone:406-234-6034
Practice Address - Fax:406-234-7018
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1105235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist