Provider Demographics
NPI:1740839125
Name:HOLMAN, KYLEE BETH (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KYLEE
Middle Name:BETH
Last Name:HOLMAN
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 1:666 FINSON RD LOT 250
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-2455
Mailing Address - Country:US
Mailing Address - Phone:207-217-0643
Mailing Address - Fax:
Practice Address - Street 1:666 FINSON RD LOT 250
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-2455
Practice Address - Country:US
Practice Address - Phone:207-217-0643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-08
Last Update Date:2019-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist