Provider Demographics
NPI:1437897873
Name:HOLT, CHEYENNE (BA)
Entity Type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:
Last Name:HOLT
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:CHEYENNE
Other - Middle Name:
Other - Last Name:HOWALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:507 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:TUSCOLA
Mailing Address - State:IL
Mailing Address - Zip Code:61953-1208
Mailing Address - Country:US
Mailing Address - Phone:217-259-8142
Mailing Address - Fax:
Practice Address - Street 1:1510 W OTTAWA RD
Practice Address - Street 2:
Practice Address - City:PAXTON
Practice Address - State:IL
Practice Address - Zip Code:60957-4090
Practice Address - Country:US
Practice Address - Phone:217-379-4302
Practice Address - Fax:217-817-0379
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker