Basic Information
| Provider Information | |||||||||
| NPI: | 1699172940 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLMAN | ||||||||
| FirstName: | JACQUELYN | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 721 COMMERCE DR | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551259118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6127677222 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 721 COMMERCE DR | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551259118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6127677222 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2014 | ||||||||
| LastUpdateDate: | 04/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 474968 | MN | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 9145 | MN | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 0001949 | CO | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 518290 | MN | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.