Provider Demographics
NPI:1841708021
Name:HOLDER, KRISTIN (LISW)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:
Last Name:HOLDER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20068
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43610-0068
Mailing Address - Country:US
Mailing Address - Phone:419-531-5544
Mailing Address - Fax:419-531-5117
Practice Address - Street 1:5301 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-4632
Practice Address - Country:US
Practice Address - Phone:419-531-5544
Practice Address - Fax:419-531-5117
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health