Provider Demographics
NPI:1750049771
Name:HOLTZ, SHAYLA RAE
Entity Type:Individual
Prefix:
First Name:SHAYLA
Middle Name:RAE
Last Name:HOLTZ
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 1:7938 COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-8636
Mailing Address - Country:US
Mailing Address - Phone:218-270-2918
Mailing Address - Fax:
Practice Address - Street 1:7938 COLLEGE RD
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-8636
Practice Address - Country:US
Practice Address - Phone:218-270-2918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician