Provider Demographics
NPI:1154694230
Name:HOLLOWAY, CHRISTA TUTTLE (MS CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:CHRISTA
Middle Name:TUTTLE
Last Name:HOLLOWAY
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 1:617 HAVANA CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-8852
Mailing Address - Country:US
Mailing Address - Phone:859-948-9308
Mailing Address - Fax:
Practice Address - Street 1:617 HAVANA CT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-8852
Practice Address - Country:US
Practice Address - Phone:859-948-9308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2917235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist