Provider Demographics
NPI:1013113422
Name:GRABERT, HOLLY L (SLP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:L
Last Name:GRABERT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MRS
Other - First Name:HOLLY
Other - Middle Name:L
Other - Last Name:GRABERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1000 PLANTATION RD STE 1A
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4264
Mailing Address - Country:US
Mailing Address - Phone:225-229-4047
Mailing Address - Fax:985-888-8747
Practice Address - Street 1:1000 PLANTATION RD STE A1
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4264
Practice Address - Country:US
Practice Address - Phone:985-387-1919
Practice Address - Fax:985-888-8747
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5751235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist