Provider Demographics
NPI:1932593977
Name:HOLMES, RONNI LEE (SLP)
Entity Type:Individual
Prefix:
First Name:RONNI
Middle Name:LEE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N SIDNEY AVE
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-4383
Mailing Address - Country:US
Mailing Address - Phone:479-890-5494
Mailing Address - Fax:
Practice Address - Street 1:301 N SIDNEY AVE
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-4383
Practice Address - Country:US
Practice Address - Phone:479-890-5494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3472235Z00000X
AR201674235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist