Provider Demographics
NPI:1952532244
Name:HOLLEY, JAMIE S (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:S
Last Name:HOLLEY
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 1:10 SPRINGBROOK DR
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:AR
Mailing Address - Zip Code:72058-9613
Mailing Address - Country:US
Mailing Address - Phone:501-679-2153
Mailing Address - Fax:
Practice Address - Street 1:4 SCHOOL DR
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:AR
Practice Address - Zip Code:72058-9267
Practice Address - Country:US
Practice Address - Phone:501-679-1057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR657235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist