Individual
DR. JASON TODD HOLDEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
3420 ILLINOIS ST, GREAT LAKES, IL 60088-3161
(847) 688-6755
(847) 688-7411
Mailing address
101 MISTY HILL LN, HAINESVILLE, IL 60030-1078
(630) 621-0368
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
20041693A
IN
103TC0700X
Clinical Psychologist
Primary
071-006876
IL
Other
Enumeration date
12/01/2005
Last updated
05/31/2016
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