Healthcare Provider Details

I. General information

NPI: 1639087794
Provider Name (Legal Business Name): GRACIE HOLSONBACK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4198 US HIGHWAY 431 STE B
ALBERTVILLE AL
35950-0242
US

IV. Provider business mailing address

455 ROY WHITT RD
BOAZ AL
35956-2537
US

V. Phone/Fax

Practice location:
  • Phone: 256-486-2300
  • Fax: 256-486-9580
Mailing address:
  • Phone: 256-960-6566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6192
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: