MEDICARE: WANDA K. HOLLOWAY PSYD, LCSW, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	000995	MO
2	1041C0700X	Clinical Social Worker	000745	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598763088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WANDA K. HOLLOWAY PSYD, LCSW, LPC

Provider Business Mailing Address
First Line	:	2885 W BATTLEFIELD ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-3952
Country	:	US
Telephone Number	:	417-761-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 E BRADFORD PKWY BLDG B
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-4264
Country	:	US
Telephone Number	:	417-761-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	02/06/2026

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