Provider Demographics
NPI:1043608706
Name:HOLT, HEATHER MARIE (MSW, LICSW)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MARIE
Last Name:HOLT
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:MARIE
Other - Last Name:VARGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1619 DAYTON AVE STE 112B
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6276
Mailing Address - Country:US
Mailing Address - Phone:612-889-7517
Mailing Address - Fax:651-389-0510
Practice Address - Street 1:1619 DAYTON AVE
Practice Address - Street 2:STE 112B
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6206
Practice Address - Country:US
Practice Address - Phone:612-889-7517
Practice Address - Fax:651-389-0510
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN217421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical