Provider Demographics
NPI:1841030079
Name:HOLLAND, ALLY COOK (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALLY
Middle Name:COOK
Last Name:HOLLAND
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 1:13640 E FURGUSON AVE
Mailing Address - Street 2:
Mailing Address - City:KAW CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74641-9641
Mailing Address - Country:US
Mailing Address - Phone:580-716-3477
Mailing Address - Fax:
Practice Address - Street 1:13640 E FURGUSON AVE
Practice Address - Street 2:
Practice Address - City:KAW CITY
Practice Address - State:OK
Practice Address - Zip Code:74641-9641
Practice Address - Country:US
Practice Address - Phone:580-716-3477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6031235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist