Provider Demographics
NPI:1629391800
Name:MCLAIN, HOLLY MALONE (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:MALONE
Last Name:MCLAIN
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5128 OLD HIGHWAY 11
Mailing Address - Street 2:STE 8
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-6233
Mailing Address - Country:US
Mailing Address - Phone:601-450-0280
Mailing Address - Fax:601-450-0282
Practice Address - Street 1:5128 OLD HIGHWAY 11
Practice Address - Street 2:STE 8
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-6233
Practice Address - Country:US
Practice Address - Phone:601-450-0280
Practice Address - Fax:601-450-0282
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA3381231H00000X, 231HA2400X, 231HA2500X, 237600000X
LA6142231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter