Provider Demographics
NPI:1194946194
Name:HOLM, CHRISTINA A (SLP)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:A
Last Name:HOLM
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:CHRISTINA
Other - Middle Name:A
Other - Last Name:FORSGREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:3316 GUILFORD RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-3412
Mailing Address - Country:US
Mailing Address - Phone:815-243-9808
Mailing Address - Fax:815-397-8263
Practice Address - Street 1:3316 GUILFORD RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-3412
Practice Address - Country:US
Practice Address - Phone:815-243-9808
Practice Address - Fax:815-397-8263
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146007353235Z00000X
IL146.007353235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist