Provider Demographics
NPI:1609395250
Name:HOLST, MORGAN NICOLE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MORGAN
Middle Name:NICOLE
Last Name:HOLST
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:MORGAN
Other - Middle Name:NICOLE
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:2595 S 70TH ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-8742
Mailing Address - Country:US
Mailing Address - Phone:309-533-3099
Mailing Address - Fax:
Practice Address - Street 1:725 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MT ZION
Practice Address - State:IL
Practice Address - Zip Code:62549-1335
Practice Address - Country:US
Practice Address - Phone:217-864-9435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-14
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.012867235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14157474OtherASHA
IL146.012867OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATIONS