Provider Demographics
NPI:1740592203
Name:MCKNIGHT, HOLLY MICHELLE (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:MICHELLE
Last Name:MCKNIGHT
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 1:5412 CORDOVA LN
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-7819
Mailing Address - Country:US
Mailing Address - Phone:870-243-8219
Mailing Address - Fax:
Practice Address - Street 1:2208 FOWLER AVE
Practice Address - Street 2:SUITE C
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6115
Practice Address - Country:US
Practice Address - Phone:870-530-0000
Practice Address - Fax:870-972-0929
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2801235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist