Provider Demographics
NPI:1023867819
Name:HOLMQUIST, ANGELA MAUREEN (LICSW, MSW)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MAUREEN
Last Name:HOLMQUIST
Suffix:
Gender:F
Credentials:LICSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3618 LAKEVIEW TRL
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-1396
Mailing Address - Country:US
Mailing Address - Phone:651-528-1449
Mailing Address - Fax:
Practice Address - Street 1:3618 LAKEVIEW TRL
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1396
Practice Address - Country:US
Practice Address - Phone:651-528-1449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN204321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical