Individual
DR. JENELL L HOLSTEAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D., NCSP
Contact information
Practice address
1050 CIRCLE DR STE B, GREEN BAY, WI 54304-5569
(920) 544-2780
Mailing address
1615 HIDDEN FALLS CT, DE PERE, WI 54115-3389
(920) 544-2780
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
103TP0814X
Psychoanalysis Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
103TS0200X
School Psychologist
Primary
—
—
Other
Enumeration date
04/16/2021
Last updated
04/16/2021
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