Individual
AUDREY GRACE HOLLAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1720 17TH ST, HUNTINGTON, WV 25701-4235
(304) 529-6031
Mailing address
1720 17TH ST, HUNTINGTON, WV 25701-4235
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-0728
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36121
—
WV
Enumeration date
09/10/2019
Last updated
09/10/2019
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