Healthcare Provider Details

I. General information

NPI: 1407680523
Provider Name (Legal Business Name): JOSHUA HOLMES LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2024
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 LUND ST N
HUDSON WI
54016-2348
US

IV. Provider business mailing address

1715 TOWER DR W STE 100
STILLWATER MN
55082-7609
US

V. Phone/Fax

Practice location:
  • Phone: 651-442-1304
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12856-123
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26782
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: