Provider Demographics
NPI:1245451046
Name:HOLMBERG, JENNIFER K (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:K
Last Name:HOLMBERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:KLIMEK
Other - Last Name:HOLMBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2200 FULLER CT
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2311
Mailing Address - Country:US
Mailing Address - Phone:734-995-0999
Mailing Address - Fax:734-665-2440
Practice Address - Street 1:2200 FULLER CT
Practice Address - Street 2:2200 FULLER COURT
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2311
Practice Address - Country:US
Practice Address - Phone:734-995-0999
Practice Address - Fax:734-665-2440
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJH012431103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI68OH149670OtherCLINICAL PSYCHOLOGIST