Individual provider Active NPI

Olivia Grace Birkholz, MS, CF-SLP

  • Speech-Language Pathologist
  • Brunswick, GA
National Provider Identifier
1275423733
Registry record updated Jul 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
PCET004214 Issued in GA
Practice address
4204 Coral Park Dr
Brunswick, GA 31520-3016
Phone
(912) 342-8875
Fax
(912) 342-8016
NPI assigned
Jul 7, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 7, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X PCET004214 GA Primary

Addresses

Primary practice location

4204 Coral Park Dr
Brunswick, GA 31520-3016

Mailing address

4204 Coral Park Dr
Brunswick, GA 31520-3016
Phone (912) 342-8875

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
PCET004214GAMDSpeech-Language Pathologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1751846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751846400000",
    "number": "1275423733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4204 CORAL PARK DR",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315203016",
            "telephone_number": "912-342-8875",
            "fax_number": "912-342-8016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4204 CORAL PARK DR",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315203016",
            "telephone_number": "912-342-8875",
            "fax_number": "912-342-8016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BIRKHOLZ",
        "first_name": "OLIVIA",
        "middle_name": "GRACE",
        "credential": "MS, CF-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-07-07",
        "last_updated": "2025-07-07",
        "certification_date": "2025-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "PCET004214",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brunswick, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.