Healthcare Provider Details

I. General information

NPI: 1164445904
Provider Name (Legal Business Name): HOLLY ANN WRIGHT LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROOSEVELT AND 5TH AVE
HINES IL
60141
US

IV. Provider business mailing address

433 S ROOSEVELT AVE
ARLINGTON HEIGHTS IL
60005-2117
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-2086
  • Fax:
Mailing address:
  • Phone: 708-202-2086
  • Fax: 708-202-2596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: