MEDICARE: MS. DONNETTE NICOLE HOLLOWAY LMSW

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
1	1041C0700X	Clinical Social Worker	8275	KS

General Provider Information

NPI Number	:	1104210905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DONNETTE NICOLE HOLLOWAY LMSW

Provider Business Mailing Address
First Line	:	7618 W 59TH TER APT 314
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66202-4417
Country	:	US
Telephone Number	:	702-327-9789
Fax Number	:

Provider Business Practice Location Address
First Line	:	7940 PARALLEL PKWY STE 1
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66112-2070
Country	:	US
Telephone Number	:	913-908-6986
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2015
Last Update Date	:	03/19/2015

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