Provider Demographics
NPI:1598428914
Name:ROBERTS, HOLLY ANN (CAPSW CSAC)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:CAPSW CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 FERRY ST
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-5944
Mailing Address - Country:US
Mailing Address - Phone:920-655-4190
Mailing Address - Fax:
Practice Address - Street 1:221 FERRY ST
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-5944
Practice Address - Country:US
Practice Address - Phone:920-655-4190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16347101YA0400X
WI1322051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)