MEDICARE: ERICA HOLWAGER

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	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	26216969985242A002	OTHER	AZ	TRICARE

General Provider Information

NPI Number	:	1356599435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA HOLWAGER

Provider Business Mailing Address
First Line	:	18521 E QUEEN CREEK RD
Second Line	:	SUITE 105-627
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-5866
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18521 E QUEEN CREEK RD
Second Line	:	SUITE 105-627
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-5866
Country	:	US
Telephone Number	:	480-361-1025
Fax Number	:

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

Provider Enumeration Date	:	09/03/2008
Last Update Date	:	10/18/2016

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