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NPI Code Detail

MEDICARE: KIMBERLY HOLTZ MS CCC-SLP

MEDICARE: KIMBERLY HOLTZ MS CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist1788-154WI

General Provider Information

NPI Number : 1982773131
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY HOLTZ MS CCC-SLP
Provider Business Mailing Address
First Line : 1673 DOUSMAN ST
Second Line :
City : GREEN BAY
State : WI
Zip : 54303-3209
Country : US
Telephone Number : 920-498-2599
Fax Number :
Provider Business Practice Location Address
First Line : 1673 DOUSMAN ST
Second Line :
City : GREEN BAY
State : WI
Zip : 54303-3209
Country : US
Telephone Number : 920-498-2599
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2006
Last Update Date : 07/08/2007

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Directions to “ KIMBERLY HOLTZ MS CCC-SLP” Practice Location

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