Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003438110 |
---|---|
Provider Name | Lesley Lynn Holmes |
First Address | Burke, SD 57533 |
Second Address | Burke, SD 57533 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2020 |
Last Update Date | 12/05/2020 |