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NPI Code Detail

MEDICARE: JODIE RAE HOLZMAN LICSW

MEDICARE: JODIE RAE HOLZMAN LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker15022MN

General Provider Information

NPI Number : 1063528818
Entity Type Code : Individual
Provider Name (Legal Business Name) : JODIE RAE HOLZMAN LICSW
Provider Business Mailing Address
First Line : 3101 SUPERIOR DR NW
Second Line :
City : ROCHESTER
State : MN
Zip : 55901-1993
Country : US
Telephone Number : 507-288-8544
Fax Number : 507-288-8544
Provider Business Practice Location Address
First Line : 3101 SUPERIOR DR NW
Second Line :
City : ROCHESTER
State : MN
Zip : 55901-1993
Country : US
Telephone Number : 507-288-8544
Fax Number : 507-288-8544
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2006
Last Update Date : 08/23/2022

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Directions to “ JODIE RAE HOLZMAN LICSW” Practice Location

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