Individual
CHRISTELLE CAROL HOLDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2108 63RD ST, KENOSHA, WI 53143-4454
(414) 475-2788
Mailing address
6233 39TH AVE, KENOSHA, WI 53142-7015
(262) 654-1004
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
131793
WI
1041C0700X
Clinical Social Worker
Primary
11468-123
WI
Other
Enumeration date
07/18/2023
Last updated
11/01/2023
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