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General NPI Number Information
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NPI Number | 1942999636
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Entity Type | Organization
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Legal Business Name | DR HEATHER HOLLEMAN LLC
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Dates
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Enumeration Date | 05/08/2023
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Last Update Date | 05/08/2023
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Provider Practice Location Address
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Address Line | 3220 E JEFFERSON BLVD
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City | SOUTH BEND
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State | IN
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Zip | 46615-3028
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Country | US
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Telephone | 574-222-2466
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Fax | 574-222-2468
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Provider Business Mailing Address
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Address Line | 18340 ROOSEVELT RD
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City | SOUTH BEND
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State | IN
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Zip | 46614-9485
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Country | US
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Telephone | 574-222-2466
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Fax | 574-222-2468
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. HEATHER HOLLEMAN
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Credential | PHD, HSPP
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Telephone | 574-222-2466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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