Provider Demographics
NPI:1952319428
Name:HOLLEMAN, JODIE L (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JODIE
Middle Name:L
Last Name:HOLLEMAN
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 1:2 CHELSEA BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-6202
Mailing Address - Country:US
Mailing Address - Phone:713-807-1131
Mailing Address - Fax:713-807-1141
Practice Address - Street 1:2 CHELSEA BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-6202
Practice Address - Country:US
Practice Address - Phone:713-807-1131
Practice Address - Fax:713-807-1141
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100051235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2045734-01Medicaid
TN528493OtherBCBS PROVIDER NUMBER