Provider Demographics
NPI:1629941679
Name:DYRUD, HOLLY (LMSW)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:DYRUD
Suffix:
Gender:F
Credentials:LMSW
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 579
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:KS
Mailing Address - Zip Code:66736-0579
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1527 MADISON ST
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:KS
Practice Address - Zip Code:66736-1751
Practice Address - Country:US
Practice Address - Phone:620-378-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMSW14350104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker