Provider Demographics
NPI:1023256575
Name:HOLTON, VICKI LYNN (MS, CCC-SCP)
Entity type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:LYNN
Last Name:HOLTON
Suffix:
Gender:F
Credentials:MS, CCC-SCP
Other - Prefix:MS
Other - First Name:VICKI
Other - Middle Name:LYNN
Other - Last Name:FIRZLAFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC-SCP
Mailing Address - Street 1:1636 ALTA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213
Mailing Address - Country:US
Mailing Address - Phone:414-453-6788
Mailing Address - Fax:
Practice Address - Street 1:316 NORTH MILWAUKEE ST
Practice Address - Street 2:SUITE 208 HERITAGE HEALTHCARE GP
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-5803
Practice Address - Country:US
Practice Address - Phone:414-615-0665
Practice Address - Fax:888-389-9031
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1558-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist