Basic Information
| Provider Information | |||||||||
| NPI: | 1609276260 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLTMAN | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | JULSRUD | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26822 LOFTON AVE | ||||||||
| Address2: | |||||||||
| City: | CHISAGO CITY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550139759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013305211 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1801 AMERICAN BLVD E STE 8 | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554251230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9527672267 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2014 | ||||||||
| LastUpdateDate: | 10/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LH60511087 | WA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 103T00000X | LP6830 | MN | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.