Provider Demographics
NPI:1013450261
Name:HOLZHAUER, KRISTIN (CCC-SLP, MA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:HOLZHAUER
Suffix:
Gender:F
Credentials:CCC-SLP, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 PAULDING AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3267
Mailing Address - Country:US
Mailing Address - Phone:917-282-9952
Mailing Address - Fax:
Practice Address - Street 1:176 PAULDING AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3267
Practice Address - Country:US
Practice Address - Phone:917-282-9952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025116-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist