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General NPI Number Information
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NPI Number | 1447767157
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Entity Type | Individual
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Provider Name | NICOLETTE VICTORIA HOLZBAUR
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Gender | Female
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Dates
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Enumeration Date | 01/03/2018
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 103 N PLAIN RD
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City | JACKSONVILLE
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State | NC
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Zip | 28546-6760
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Country | US
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Telephone | 888-258-6905
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Fax | 888-258-6905
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Provider Business Mailing Address
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Address Line | 1651 OLD MEADOW RD
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City | MC LEAN
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State | VA
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Zip | 22102-4311
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 41YS01170900
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 30003921
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License Number State | NC
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