Provider Demographics
NPI:1619040359
Name:LANTZ, HOLLY L (AUD, F-AAA)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:L
Last Name:LANTZ
Suffix:
Gender:F
Credentials:AUD, F-AAA
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 1291
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452-1291
Mailing Address - Country:US
Mailing Address - Phone:304-269-2435
Mailing Address - Fax:
Practice Address - Street 1:37 GARTON PLZ
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-2128
Practice Address - Country:US
Practice Address - Phone:304-269-2435
Practice Address - Fax:304-269-2435
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVA-0192231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3403010000Medicaid
WVLA4106521Medicare ID - Type UnspecifiedAUDIOLOGIST