Individual
LEAH HOLSTEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4407 NUNDA AVE, CRYSTAL LAKE, IL 60014-2538
(815) 670-3688
Mailing address
4407 NUNDA AVE, CRYSTAL LAKE, IL 60014-2538
(815) 670-3688
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H42353692795
DEVELOPMENTAL THERAPIST
IL
Enumeration date
05/25/2018
Last updated
06/16/2018
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