Provider Demographics
NPI:1346443561
Name:HOLMES, MARILYN EDITH (LISW)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:EDITH
Last Name:HOLMES
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MS
Other - First Name:MARILYN
Other - Middle Name:EDITH
Other - Last Name:MCCALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW
Mailing Address - Street 1:5250 N PARK PL NE STE 209
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-6221
Mailing Address - Country:US
Mailing Address - Phone:319-377-2161
Mailing Address - Fax:319-377-2094
Practice Address - Street 1:5250 N PARK PL NE STE 209
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-6221
Practice Address - Country:US
Practice Address - Phone:319-377-2161
Practice Address - Fax:319-377-2094
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA009621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical