Provider Demographics
NPI:1467411165
Name:HOLCOMB, CONNIE S (CCC/SLP)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:S
Last Name:HOLCOMB
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:S
Other - Last Name:HOLCOMB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC/SLP
Mailing Address - Street 1:2228 STARLING ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4200
Mailing Address - Country:US
Mailing Address - Phone:912-264-3141
Mailing Address - Fax:912-264-6190
Practice Address - Street 1:2228 STARLING ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4200
Practice Address - Country:US
Practice Address - Phone:912-264-3141
Practice Address - Fax:912-264-6190
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3279235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA16505Medicare ID - Type UnspecifiedPROVIDER NUMBER