Healthcare Provider Details

I. General information

NPI: 1174236442
Provider Name (Legal Business Name): SYLVIA HOLMSTROM BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 HANLEY RD STE 201
HUDSON WI
54016-8786
US

IV. Provider business mailing address

2620 STEIN BLVD STE B
EAU CLAIRE WI
54701-2674
US

V. Phone/Fax

Practice location:
  • Phone: 534-544-5247
  • Fax: 534-544-5248
Mailing address:
  • Phone: 715-836-0064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number136483-121
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: