MEDICARE: RUTH ALICE HOLMQUIST APSW CSAC CADCIII

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	12971 132	WI
2	101YM0800X	Mental Health Counselor	356 121	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851428528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH ALICE HOLMQUIST APSW CSAC CADCIII

Provider Business Mailing Address
First Line	:	PO BOX 588
Second Line	:
City	:	GREEN LAKE
State	:	WI
Zip	:	54941-0588
Country	:	US
Telephone Number	:	920-294-4070
Fax Number	:	920-294-4139

Provider Business Practice Location Address
First Line	:	571 COUNTY RD A
Second Line	:
City	:	GREEN LAKE
State	:	WI
Zip	:	54941-9798
Country	:	US
Telephone Number	:	920-294-4070
Fax Number	:	920-294-4139

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

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	08/17/2010

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