Provider Demographics
NPI:1841361193
Name:HOLIFIELD, JULIE CAROLE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:CAROLE
Last Name:HOLIFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:HOLIFIELD
Other - Last Name:SANDOVAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:843 COLONITAS COMPESTRES
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1133
Mailing Address - Country:US
Mailing Address - Phone:505-920-8244
Mailing Address - Fax:505-954-9946
Practice Address - Street 1:1800 OLD PECOS TRL
Practice Address - Street 2:SUITE G
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4759
Practice Address - Country:US
Practice Address - Phone:505-954-9940
Practice Address - Fax:505-954-9946
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2423235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist