Provider Demographics
NPI:1023514536
Name:AUKEMAN, HOLLY JO
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:JO
Last Name:AUKEMAN
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 1:5511 FILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-7382
Mailing Address - Country:US
Mailing Address - Phone:616-821-8011
Mailing Address - Fax:
Practice Address - Street 1:5511 FILLMORE ST
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-7382
Practice Address - Country:US
Practice Address - Phone:616-821-8011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician