Provider Demographics
NPI:1356329296
Name:HOLLIDGE, EMILY (MSW LICSW)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:
Last Name:HOLLIDGE
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4555 ERIN DR
Mailing Address - Street 2:SUITE 260
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-3398
Mailing Address - Country:US
Mailing Address - Phone:651-686-8818
Mailing Address - Fax:
Practice Address - Street 1:2130 CLIFF RD
Practice Address - Street 2:STE 210A
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2487
Practice Address - Country:US
Practice Address - Phone:651-686-8818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-31
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13536104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker