Provider Demographics
NPI:1649315235
Name:HOLMES, ENEDELIA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ENEDELIA
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 N VERMONT SUITE 2
Mailing Address - Street 2:QTP II INC
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570
Mailing Address - Country:US
Mailing Address - Phone:956-514-1551
Mailing Address - Fax:956-514-1554
Practice Address - Street 1:50 N VERMONT SUITE 2
Practice Address - Street 2:QTP II INC
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570
Practice Address - Country:US
Practice Address - Phone:956-514-1551
Practice Address - Fax:956-514-1554
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15242235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist