Basic Information
| Provider Information | |||||||||
| NPI: | 1912095688 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCINTYRE | ||||||||
| FirstName: | HOLLY | ||||||||
| MiddleName: | BRIANNE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.S., CCC SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 48 GABLES PL | ||||||||
| Address2: | |||||||||
| City: | BRIDGEPORT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 263309247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045141057 | ||||||||
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| Practice Location | |||||||||
| Address1: | 230 GRANDE MDWS | ||||||||
| Address2: | |||||||||
| City: | BRIDGEPORT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 263309711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045922009 | ||||||||
| FaxNumber: | 3045922004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SLP-1025 | WV | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.