Provider Demographics
NPI:1912095704
Name:HOLMAN, DEENA MARIE (MS, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:DEENA
Middle Name:MARIE
Last Name:HOLMAN
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 1:1000 W VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-2068
Mailing Address - Country:US
Mailing Address - Phone:217-821-6741
Mailing Address - Fax:
Practice Address - Street 1:1000 W VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2068
Practice Address - Country:US
Practice Address - Phone:217-821-6741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.006167235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist