Provider Demographics
NPI:1861683484
Name:HOLMER, HEIDI A (LISW)
Entity Type:Individual
Prefix:MISS
First Name:HEIDI
Middle Name:A
Last Name:HOLMER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 UNION ST STE B1
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-3998
Mailing Address - Country:US
Mailing Address - Phone:740-349-7066
Mailing Address - Fax:740-345-6028
Practice Address - Street 1:195 UNION ST STE B1
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-3998
Practice Address - Country:US
Practice Address - Phone:740-349-7066
Practice Address - Fax:740-345-6028
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00310271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH10193Medicaid
OH1376607374OtherORGANIZATION NPI#
OH1376607374OtherORGANIZATION NPI#