MEDICARE: HOLLIE CARLSON

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	104100000X	Social Worker	11614-123	WI

General Provider Information

NPI Number	:	1750027694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLIE CARLSON

Provider Business Mailing Address
First Line	:	1005 BREWSTER DR APT 6
Second Line	:
City	:	LAKE MILLS
State	:	WI
Zip	:	53551-1787
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	524 W VERONA AVE STE 105
Second Line	:
City	:	VERONA
State	:	WI
Zip	:	53593-1443
Country	:	US
Telephone Number	:	608-845-2081
Fax Number	:

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

Provider Enumeration Date	:	05/11/2022
Last Update Date	:	11/21/2024

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Directions to “ HOLLIE CARLSON ” Practice Location

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