Provider Demographics
NPI:1811124696
Name:HOLMBERG, ALLISON COLLEEN (MS CCC-SLP/A)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:COLLEEN
Last Name:HOLMBERG
Suffix:
Gender:F
Credentials:MS CCC-SLP/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 KING ST STE 105
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2367
Mailing Address - Country:US
Mailing Address - Phone:413-586-9572
Mailing Address - Fax:
Practice Address - Street 1:243 KING ST STE 105
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060
Practice Address - Country:US
Practice Address - Phone:413-586-9572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2018-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3388235Z00000X
MA486231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist