Healthcare Provider Details

I. General information

NPI: 1851591903
Provider Name (Legal Business Name): ROBERT HOLTON CCC/SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 27TH ST
LUBBOCK TX
79410-1709
US

IV. Provider business mailing address

9709 KNOXVILLE AVE
LUBBOCK TX
79423-3817
US

V. Phone/Fax

Practice location:
  • Phone: 806-785-2464
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number15684
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: