Healthcare Provider Details

I. General information

NPI: 1093356776
Provider Name (Legal Business Name): COURTNEY KAY HOALT MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2019
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 W CONDIT ST
ROBINSON IL
62454-1962
US

IV. Provider business mailing address

401 N ALLEN ST
ROBINSON IL
62454-1206
US

V. Phone/Fax

Practice location:
  • Phone: 618-544-2233
  • Fax:
Mailing address:
  • Phone: 618-554-3382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: