Provider Demographics
NPI:1790223063
Name:HOLTVLUWER, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HOLTVLUWER
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 1:255 COLRAIN ST SW STE 2
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548-1057
Mailing Address - Country:US
Mailing Address - Phone:616-581-8757
Mailing Address - Fax:616-988-1493
Practice Address - Street 1:255 COLRAIN ST SW STE 2
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49548-1057
Practice Address - Country:US
Practice Address - Phone:616-581-8757
Practice Address - Fax:616-988-1493
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011067031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical