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General NPI Number Information
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NPI Number | 1801477377
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Entity Type | Individual
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Provider Name | JENELL L HOLSTEAD PH.D., NCSP
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Gender | Female
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Dates
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Enumeration Date | 04/16/2021
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Last Update Date | 04/16/2021
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Provider Practice Location Address
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Address Line | 1050 CIRCLE DR STE B
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City | GREEN BAY
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State | WI
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Zip | 54304-5569
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Country | US
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Telephone | 920-544-2780
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Fax |
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Provider Business Mailing Address
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Address Line | 1615 HIDDEN FALLS CT
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City | DE PERE
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State | WI
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Zip | 54115-3389
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Country | US
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Telephone | 920-544-2780
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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 | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number |
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Taxonomy #2
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Taxonomy Code | 103TP0814X
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Taxonomy Name | Psychoanalysis Psychologist
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Taxonomy #3
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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Taxonomy #4
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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