1023256575 NPI number — MRS. VICKI LYNN HOLTON MS, CCC-SCP

Table of content: MRS. VICKI LYNN HOLTON MS, CCC-SCP (NPI 1023256575)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023256575 NPI number — MRS. VICKI LYNN HOLTON MS, CCC-SCP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLTON
Provider First Name:
VICKI
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, CCC-SCP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FIRZLAFF
Provider Other First Name:
VICKI
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, CCC-SCP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1023256575
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1636 ALTA VISTA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAUWATOSA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-453-6788
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
316 NORTH MILWAUKEE ST
Provider Second Line Business Practice Location Address:
SUITE 208 HERITAGE HEALTHCARE GP
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53202-5803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-615-0665
Provider Business Practice Location Address Fax Number:
888-389-9031
Provider Enumeration Date:
01/21/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  1558-154 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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