Provider Demographics
NPI:1548548589
Name:HOLMES, CORRIE ELIZABETH (AUD)
Entity type:Individual
Prefix:
First Name:CORRIE
Middle Name:ELIZABETH
Last Name:HOLMES
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 S 8TH AVE STOP 8116
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83209-0001
Mailing Address - Country:US
Mailing Address - Phone:208-282-3495
Mailing Address - Fax:208-282-4571
Practice Address - Street 1:650 MEMORIAL DRIVE BUILDING 68
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83209
Practice Address - Country:US
Practice Address - Phone:208-282-3495
Practice Address - Fax:208-282-4571
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAUD-2521231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist