Provider Demographics
NPI:1447488820
Name:HOLT, VICTORIA K (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:K
Last Name:HOLT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3914 RIVERVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-2036
Mailing Address - Country:US
Mailing Address - Phone:941-737-9275
Mailing Address - Fax:
Practice Address - Street 1:2620 MANATEE AVE W STE C
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-4944
Practice Address - Country:US
Practice Address - Phone:941-807-2863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 10603235Z00000X
IL242001193235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist