Provider Demographics
NPI:1396002655
Name:HOLZER, KENDRA A (LP)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:A
Last Name:HOLZER
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:A
Other - Last Name:ELLENBECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1212 E COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-2010
Mailing Address - Country:US
Mailing Address - Phone:507-532-3236
Mailing Address - Fax:507-532-0240
Practice Address - Street 1:1212 E COLLEGE DR
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-2010
Practice Address - Country:US
Practice Address - Phone:507-532-3236
Practice Address - Fax:507-532-0240
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 5480103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical