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General NPI Number Information
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NPI Number | 1801845805
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Entity Type | Individual
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Provider Name | DONNA JEAN HOLST MSW, LCSW, LAT
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Gender | Female
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 05/17/2012
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Provider Practice Location Address
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Address Line | 1221 W 5TH ST
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City | SHERIDAN
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State | WY
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Zip | 82801-2701
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Country | US
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Telephone | 307-674-4405
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Fax |
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Provider Business Mailing Address
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Address Line | 1508 HILLPOND DR
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City | SHERIDAN
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State | WY
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Zip | 82801-2120
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Country | US
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Telephone | 307-461-0412
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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 | LCSW# 495
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License Number State | WY
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