Provider Demographics
NPI:1821384223
Name:HOLBROOK, LANIE MICHELLE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LANIE
Middle Name:MICHELLE
Last Name:HOLBROOK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5970 S ROCK CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-2837
Mailing Address - Country:US
Mailing Address - Phone:801-458-9144
Mailing Address - Fax:
Practice Address - Street 1:5970 S ROCK CREEK DR
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-2837
Practice Address - Country:US
Practice Address - Phone:801-458-9144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12141801235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist