Healthcare Provider Details

I. General information

NPI: 1841361193
Provider Name (Legal Business Name): JULIE CAROLE HOLIFIELD MADRID
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 S WALTON BLVD
BENTONVILLE AR
72712-7172
US

IV. Provider business mailing address

1720 S WALTON BLVD STE 4
BENTONVILLE AR
72712-7533
US

V. Phone/Fax

Practice location:
  • Phone: 505-954-9940
  • Fax:
Mailing address:
  • Phone: 505-501-9289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number203189
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2423
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: