Provider Demographics
NPI:1558950709
Name:HOLSCLAW, CINNAMON RENE (CSW, MA ED)
Entity Type:Individual
Prefix:
First Name:CINNAMON
Middle Name:RENE
Last Name:HOLSCLAW
Suffix:
Gender:F
Credentials:CSW, MA ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 W INDUSTRIAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-7118
Mailing Address - Country:US
Mailing Address - Phone:435-274-7080
Mailing Address - Fax:
Practice Address - Street 1:418 W INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-7118
Practice Address - Country:US
Practice Address - Phone:435-274-7080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical