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NPI Code Detail

MEDICARE: KENZIE HOLM

MEDICARE: KENZIE HOLM
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
1104100000XSocial Worker6316ND

General Provider Information

NPI Number : 1295695377
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENZIE HOLM
Provider Business Mailing Address
First Line : 2400 47TH AVE S
Second Line :
City : GRAND FORKS
State : ND
Zip : 58201-3405
Country : US
Telephone Number : 701-746-2200
Fax Number :
Provider Business Practice Location Address
First Line : 2400 47TH AVE S
Second Line :
City : GRAND FORKS
State : ND
Zip : 58201-3405
Country : US
Telephone Number : 701-746-2200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/12/2025
Last Update Date : 11/19/2025

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Directions to “ KENZIE HOLM ” Practice Location

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