Provider Demographics
NPI:1629144241
Name:HOLMES, VANESSA D (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:D
Last Name:HOLMES
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:AR
Mailing Address - Zip Code:72104-5600
Mailing Address - Country:US
Mailing Address - Phone:501-337-7622
Mailing Address - Fax:501-332-3439
Practice Address - Street 1:1625 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-5600
Practice Address - Country:US
Practice Address - Phone:501-337-7622
Practice Address - Fax:501-332-3439
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP1775235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5W446OtherBCBS
AR142739721Medicare ID - Type Unspecified