Provider Demographics
NPI:1558660233
Name:HOLDINGHAUS, JESSICA FRIZ
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:FRIZ
Last Name:HOLDINGHAUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-4517
Mailing Address - Country:US
Mailing Address - Phone:573-424-1347
Mailing Address - Fax:
Practice Address - Street 1:811 N 8TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-4517
Practice Address - Country:US
Practice Address - Phone:573-424-1347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010027262104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker