Healthcare Provider Details

I. General information

NPI: 1679069819
Provider Name (Legal Business Name): JOHN HAYDEN HOLTZCLAW AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2449 HOSPITAL DR STE 280
BOSSIER CITY LA
71111-1900
US

IV. Provider business mailing address

2449 HOSPITAL DR STE 280
BOSSIER CITY LA
71111-1900
US

V. Phone/Fax

Practice location:
  • Phone: 318-212-7288
  • Fax: 318-212-7295
Mailing address:
  • Phone: 318-212-7288
  • Fax: 318-212-7295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number80958
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: