Provider Demographics
NPI:1588710867
Name:NOBLE, HOLLY LYNN (MACCCSLP)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:LYNN
Last Name:NOBLE
Suffix:
Gender:F
Credentials:MACCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 ELK DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-7290
Mailing Address - Country:US
Mailing Address - Phone:573-431-1893
Mailing Address - Fax:
Practice Address - Street 1:403 HOVIS FARM RD
Practice Address - Street 2:
Practice Address - City:PARK HILLS
Practice Address - State:MO
Practice Address - Zip Code:63601-8248
Practice Address - Country:US
Practice Address - Phone:573-701-2867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO114824235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist