Provider Demographics
NPI:1538421425
Name:HOLLOMAN, JENNIFER MARIE (LAC,LMT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:HOLLOMAN
Suffix:
Gender:F
Credentials:LAC,LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 12TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-8579
Mailing Address - Country:US
Mailing Address - Phone:425-260-7466
Mailing Address - Fax:
Practice Address - Street 1:410 CENTRAL AVE STE 321
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3128
Practice Address - Country:US
Practice Address - Phone:406-761-3808
Practice Address - Fax:406-761-3566
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60594255171100000X
MT3416225700000X
WAMA 60214606225700000X
MT246171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist