Provider Demographics
NPI:1578454732
Name:HOLLOWAY-SANDIFER, JOSHALYN (SLP)
Entity type:Individual
Prefix:
First Name:JOSHALYN
Middle Name:
Last Name:HOLLOWAY-SANDIFER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 PINEDALE RD
Mailing Address - Street 2:
Mailing Address - City:TERRY
Mailing Address - State:MS
Mailing Address - Zip Code:39170-9646
Mailing Address - Country:US
Mailing Address - Phone:601-953-8020
Mailing Address - Fax:
Practice Address - Street 1:4215 LAKELAND DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9212
Practice Address - Country:US
Practice Address - Phone:601-932-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4254235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist