Provider Demographics
NPI:1023736261
Name:KINCAID, HOLLY KAY (MS/CCC-SLP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:KAY
Last Name:KINCAID
Suffix:
Gender:F
Credentials:MS/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:PO BOX 1117
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75456-1117
Mailing Address - Country:US
Mailing Address - Phone:903-575-2079
Mailing Address - Fax:903-575-2019
Practice Address - Street 1:2230 NORTH EDWARDS
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455
Practice Address - Country:US
Practice Address - Phone:903-575-2079
Practice Address - Fax:903-575-2019
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100861235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist