Provider Demographics
NPI:1205910783
Name:HOLDEMAN, GAIL ENID (MSW LICSW)
Entity type:Individual
Prefix:MS
First Name:GAIL
Middle Name:ENID
Last Name:HOLDEMAN
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 89TH AVENUE NE
Mailing Address - Street 2:SUITE 375
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-1212
Mailing Address - Country:US
Mailing Address - Phone:763-783-4990
Mailing Address - Fax:763-783-4756
Practice Address - Street 1:1201 89TH AVENUE NE
Practice Address - Street 2:SUITE 375
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-1212
Practice Address - Country:US
Practice Address - Phone:763-783-4990
Practice Address - Fax:763-783-4756
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN108985OtherU CARE
MN6204870OtherMEDICA INSURANCE
MNBG155CEOtherBC BS