Provider Demographics
NPI:1740561232
Name:HOLZMAN, JESSICA (MSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HOLZMAN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:MILES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:36 CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:IL
Mailing Address - Zip Code:60022-1302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:36 CRESCENT DR
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:IL
Practice Address - Zip Code:60022-1302
Practice Address - Country:US
Practice Address - Phone:847-899-1461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst