Provider Demographics
NPI:1396097325
Name:HOLDER, BRITINI L (MED CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:BRITINI
Middle Name:L
Last Name:HOLDER
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2704 NORTH OAK ST.
Mailing Address - Street 2:BLDG K
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1769
Mailing Address - Country:US
Mailing Address - Phone:229-219-7993
Mailing Address - Fax:229-219-7914
Practice Address - Street 1:2300 E PINETREE BLVD
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-4825
Practice Address - Country:US
Practice Address - Phone:229-834-5791
Practice Address - Fax:229-584-5979
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008338235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist