Provider Demographics
NPI:1851406078
Name:HOLSMAN, SUE
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:HOLSMAN
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 1:5206 N AUTUMN LN
Mailing Address - Street 2:
Mailing Address - City:MC FARLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53558-8614
Mailing Address - Country:US
Mailing Address - Phone:608-838-4323
Mailing Address - Fax:
Practice Address - Street 1:122 E OLIN AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-1487
Practice Address - Country:US
Practice Address - Phone:608-255-9119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI562-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist