Provider Demographics
NPI:1760111363
Name:HOLBROOK, KORI JOAN
Entity Type:Individual
Prefix:
First Name:KORI
Middle Name:JOAN
Last Name:HOLBROOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 N SCOTTSDALE RD APT 1042
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-1568
Mailing Address - Country:US
Mailing Address - Phone:530-867-5462
Mailing Address - Fax:
Practice Address - Street 1:1535 N SCOTTSDALE RD APT 1042
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-1568
Practice Address - Country:US
Practice Address - Phone:530-867-5462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA136922355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant