Provider Demographics
NPI:1841361193
Name:HOLIFIELD MADRID, JULIE CAROLE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:CAROLE
Last Name:HOLIFIELD MADRID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 S WALTON BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7533
Mailing Address - Country:US
Mailing Address - Phone:505-501-9289
Mailing Address - Fax:
Practice Address - Street 1:1720 S WALTON BLVD
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-7172
Practice Address - Country:US
Practice Address - Phone:505-954-9940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR203189235Z00000X
NM2423235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist