Provider Demographics
NPI:1912095688
Name:MCINTYRE, HOLLY BRIANNE (MS, CCC SLP)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:BRIANNE
Last Name:MCINTYRE
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 1:48 GABLES PL
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-9247
Mailing Address - Country:US
Mailing Address - Phone:304-514-1057
Mailing Address - Fax:
Practice Address - Street 1:230 GRANDE MDWS
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-9711
Practice Address - Country:US
Practice Address - Phone:304-592-2009
Practice Address - Fax:304-592-2004
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-1025235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist