Provider Demographics
NPI:1831610682
Name:HOLMES, HEATHER (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:HEATHER
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 1:10359 S NATHAN ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-1839
Mailing Address - Country:US
Mailing Address - Phone:817-454-4008
Mailing Address - Fax:
Practice Address - Street 1:316 E 8TH ST
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-4616
Practice Address - Country:US
Practice Address - Phone:918-758-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-02
Last Update Date:2017-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist