MEDICARE: HOLLY MASON MSW, LCSW

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	1041C0700X	Clinical Social Worker	9714-123	WI

General Provider Information

NPI Number	:	1861330565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY MASON MSW, LCSW

Provider Business Mailing Address
First Line	:	2800 E ENTERPRISE AVE STE 333
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54913-7889
Country	:	US
Telephone Number	:	414-414-6117
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 E ENTERPRISE AVE STE 333
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54913-7889
Country	:	US
Telephone Number	:	414-414-6117
Fax Number	:

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

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	05/28/2026

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