Provider Demographics
NPI:1689819583
Name:HOLLEY, SAMANTHA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:HOLLEY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:CARIWON CHILDRENS PEDIATRIC THERAPY DEPARTMENT
Mailing Address - Street 2:4348 ELECTRIC RD 1ST FLOOR
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018
Mailing Address - Country:US
Mailing Address - Phone:540-769-0974
Mailing Address - Fax:540-857-5384
Practice Address - Street 1:CARIWON CHILDRENS PEDIATRIC THERAPY DEPARTMENT
Practice Address - Street 2:4348 ELECTRIC RD 1ST FLOOR
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018
Practice Address - Country:US
Practice Address - Phone:540-769-0974
Practice Address - Fax:540-857-5384
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005305235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004979061Medicaid
VA004979061Medicaid