Healthcare Provider Details

I. General information

NPI: 1366611733
Provider Name (Legal Business Name): JOAN HOLMGREN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E WILLOW AVE
WHEATON IL
60187-5426
US

IV. Provider business mailing address

1189 WINDING GLEN DR
CAROL STREAM IL
60188-6089
US

V. Phone/Fax

Practice location:
  • Phone: 630-784-4900
  • Fax: 630-682-5276
Mailing address:
  • Phone: 630-830-4632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: