Provider Demographics
NPI:1881664860
Name:THORESON-HOLCOMB, LINDA K (MSW)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:K
Last Name:THORESON-HOLCOMB
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:K
Other - Last Name:HOLCOMB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:3601 CANYON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702
Mailing Address - Country:US
Mailing Address - Phone:605-341-8647
Mailing Address - Fax:605-341-0489
Practice Address - Street 1:3601 CANYON LAKE DR
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702
Practice Address - Country:US
Practice Address - Phone:605-341-8647
Practice Address - Fax:605-341-0489
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSDCSWPIP946104100000X
SDSDLMFT1033106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0004392OtherBLUE CROSS/BLUE SHIELD
SD6570530Medicaid
SD101811Medicare PIN