Provider Demographics
NPI:1457677098
Name:WHITAKER, HOLLY ELIZABETH (SLP)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:ELIZABETH
Last Name:WHITAKER
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 1:20 OAK HILL RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-1002
Mailing Address - Country:US
Mailing Address - Phone:606-678-8566
Mailing Address - Fax:606-676-0017
Practice Address - Street 1:20 OAK HILL RD
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-1002
Practice Address - Country:US
Practice Address - Phone:606-678-8566
Practice Address - Fax:606-676-0017
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0561235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist