1487828760 NPI number — MS. HOLLY NICOLE STEWART M.S. CCC-SLP

Table of content: JOHN STOCKTON ADAMS MFT (NPI 1124211784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487828760 NPI number — MS. HOLLY NICOLE STEWART M.S. CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEWART
Provider First Name:
HOLLY
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S. CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487828760
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
437 GEORGE TAYLOR RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPENCER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24165-3319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-957-1641
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
797 WOODLAND DR
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
STUART
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24171-5132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-694-0124
Provider Business Practice Location Address Fax Number:
276-694-0125
Provider Enumeration Date:
04/17/2008

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:  2202004307 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2026 www.npivalidator.com