Provider Demographics
NPI:1831898154
Name:KNOX, HOLLY ANN (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANN
Last Name:KNOX
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 BOARDMAN DR
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-4710
Mailing Address - Country:US
Mailing Address - Phone:505-721-1000
Mailing Address - Fax:505-721-1099
Practice Address - Street 1:345 BASILEO DR
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-4655
Practice Address - Country:US
Practice Address - Phone:505-721-1800
Practice Address - Fax:505-721-1899
Is Sole Proprietor?:No
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSLP22024235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist