Provider Demographics
NPI:1750757605
Name:HOLLY MCDOUGALD
Entity type:Organization
Organization Name:HOLLY MCDOUGALD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLPA
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDOUGALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-678-0348
Mailing Address - Street 1:1226 N NEWTON AVE
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-3234
Mailing Address - Country:US
Mailing Address - Phone:870-677-0348
Mailing Address - Fax:
Practice Address - Street 1:1226 N NEWTON AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-3234
Practice Address - Country:US
Practice Address - Phone:870-677-0348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)