Provider Demographics
NPI:1336949452
Name:HOLT, SUSAN RITCHIE (DI)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:RITCHIE
Last Name:HOLT
Suffix:
Gender:
Credentials:DI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:762 ROLLING MEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:GRAND RIVERS
Mailing Address - State:KY
Mailing Address - Zip Code:42045-9194
Mailing Address - Country:US
Mailing Address - Phone:270-816-0866
Mailing Address - Fax:
Practice Address - Street 1:762 ROLLING MEADOWS RD
Practice Address - Street 2:
Practice Address - City:GRAND RIVERS
Practice Address - State:KY
Practice Address - Zip Code:42045-9194
Practice Address - Country:US
Practice Address - Phone:270-816-0866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency