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General NPI Number Information
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NPI Number | 1629706825
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Entity Type | Individual
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Provider Name | ALISIA NICOLE QUIGLEY-HOLMBECK MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/15/2022
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Last Update Date | 08/15/2022
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Provider Practice Location Address
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Address Line | 1431 LOURDES RD
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City | METAMORA
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State | IL
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Zip | 61548-7609
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Country | US
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Telephone | 815-343-2636
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Fax |
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Provider Business Mailing Address
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Address Line | 9364 E 1175TH ST
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City | GRANVILLE
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State | IL
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Zip | 61326-9486
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Country | US
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Telephone | 815-343-2636
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.024697
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License Number State | IL
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