Holly Wallace, M.ED., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2202003129 Issued in VA

Practice address

4560 Princess Anne Rd
Virginia Beach, VA 23462-7905

Phone

(757) 474-1289

NPI assigned

Jul 2, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

State licenses

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

{
    "created_epoch": "1246492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1246492800000",
    "number": "1417186172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1213 WORTHINGTON LN",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234645854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4560 PRINCESS ANNE RD",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234627905",
            "telephone_number": "757-474-1289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "HOLLY",
        "name_prefix": "Mrs.",
        "credential": "M.ED., CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-07-02",
        "last_updated": "2009-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "VA",
            "license": "2202003129",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VIRGINIA SLP LICENSE",
            "identifier": "2202003129",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Walko Enterprise Incorporated
• Jordan Kyle Wall
• Ashley Wallace
• Casey L. Wallace, PT, DPT
• Cynthia Wallace, L.AC.
• Kiyosia Wallace
• Marsha Wallace
• Nicole Marie Wallace, PT
• Quanesha Wallace, LPC-R
• Shayla Wallace

• Speech-Language Pathologist in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Speech-Language Pathologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2009; 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.