Provider Demographics
NPI:1518020403
Name:HOLMAN, ROBERTA L (MS, CADC)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:L
Last Name:HOLMAN
Suffix:
Gender:F
Credentials:MS, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-4200
Mailing Address - Country:US
Mailing Address - Phone:608-785-0001
Mailing Address - Fax:608-785-0002
Practice Address - Street 1:409 COUNTY ROAD R
Practice Address - Street 2:
Practice Address - City:BLACK RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54615-5129
Practice Address - Country:US
Practice Address - Phone:715-284-9477
Practice Address - Fax:715-284-5547
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
51172OtherSECURITY HEALTH PLAN
HP80839OtherHEALTHPARTNERS
WI39728900Medicaid
WI000084005Medicare PIN