Healthcare Provider Details

I. General information

NPI: 1790737435
Provider Name (Legal Business Name): MARILYN C HOLSCHUH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 S YELLOWSTONE DR STE 106
MADISON WI
53719-1096
US

IV. Provider business mailing address

6510 GRAND TETON PLZ SUITE 406
MADISON WI
53719-1029
US

V. Phone/Fax

Practice location:
  • Phone: 608-268-0341
  • Fax: 608-268-0342
Mailing address:
  • Phone: 608-833-9290
  • Fax: 608-833-9691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number523-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: