Provider Demographics
NPI:1033254693
Name:HOLMAN, MOLLIE ELANA (MSW)
Entity Type:Individual
Prefix:MS
First Name:MOLLIE
Middle Name:ELANA
Last Name:HOLMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 STATION BLVD APT 505
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-4078
Mailing Address - Country:US
Mailing Address - Phone:331-444-2562
Mailing Address - Fax:
Practice Address - Street 1:1020 E OGDEN AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8609
Practice Address - Country:US
Practice Address - Phone:217-766-6488
Practice Address - Fax:630-420-9708
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0135091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical