Provider Demographics
NPI:1063742195
Name:HOLZKNECHT, STEPHANIE (MSCCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:HOLZKNECHT
Suffix:
Gender:F
Credentials:MSCCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9130 JUNEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-4112
Mailing Address - Country:US
Mailing Address - Phone:916-539-0175
Mailing Address - Fax:
Practice Address - Street 1:9130 JUNEWOOD LN
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-4112
Practice Address - Country:US
Practice Address - Phone:916-539-0175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP8791235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist