DR. JASON TODD HOLDEMAN (NPI# 1952385148) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952385148 |
| Entity Type | Individual |
| Full Name | DR. JASON TODD HOLDEMAN |
| Credential | PSY.D. |
| Practice Address |
3420 Illinois St Great Lakes IL 60088-3161 |
| Mailing Address |
101 Misty Hill Ln Hainesville IL 60030-1078 |
| Practice Telephone | 8476886755 |
| Practice Fax Number | 8476887411 |
| Mailing Telephone | 6306210368 |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2016-05-31 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103T00000X | Psychologist | 20041693A | IN | Behavioral Health & Social Service Providers |
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
071-006876 | IL | Behavioral Health & Social Service Providers |
| Street Address |
3420 ILLINOIS ST |
| City | GREAT LAKES |
| State | IL |
| Zip Code | 60088-3161 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750851788 | Claire Kubiesa | Psychologist | 3420 Illinois St, Great Lakes, IL 60088-3161 | 2018-12-03 |
| 1003342536 | Emily J Baker | Physical Therapist | 3420 Illinois St, Great Lakes, IL 60088-3161 | 2017-05-03 |
| 1346603594 | Laura Megan Logeman | Physician Assistant | 3420 Illinois St, Great Lakes, IL 60088-3161 | 2016-04-04 |
| 1225407539 | Kevin O'connor | Physician Assistant | 3420 Illinois St, Great Lakes, IL 60088-3161 | 2015-09-16 |
| 1245595776 | Alma Teresa C Molino | Psychologist | 3420 Illinois St, Great Lakes, IL 60088-3161 | 2012-07-10 |
| 1245529304 | Erin Graham | Student in an Organized Health Care Education/Training Program | 3420 Illinois St, Bldg 1007, Great Lakes, IL 60088-3161 | 2011-03-29 |
| 1588895742 | Kermit Salivia | Family Medicine | 3420 Illinois St, Great Lakes, IL 60088-3161 | 2009-08-05 |
| 1083898290 | Warren K Kennedy | Physician Assistant | 3420 Illinois St, Great Lakes, IL 60088-3120 | 2007-12-24 |
| 1346435112 | Jason Yungsup Kim | Family Medicine | 3420 Illinois St, Uss Tranquillity Clinic 1007, Great Lakes, IL 60088-3161 | 2007-09-13 |
| 1972793909 | Brett Staib | Military Health Care Provider | 3420 Illinois St, Bhc 1007, Great Lakes, IL 60088-3120 | 2007-07-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043858228 | Kathryn Ann Bird | Dentist | 3440 W Ohio St, Uss Osborne Branch Dental Clinic, Great Lakes, IL 60088 | 2019-12-18 |
| 1740775576 | Jonathan William Criter | Dentist | 3400 Ohio St, Great Lakes, IL 60088 | 2018-06-25 |
| 1134598733 | True Xiong | Dentist | Zachary & Elizabeth Fisher Medical & Dental Clinic, 2470 Sampson Street, Apo, AA 60088 | 2015-09-24 |
| 1447685771 | Lisa Carol Perrone | Dentist | Fhcc Lovell Bldg 237 Dental, Navsta Great Lakes, North Chicago, IL 60088 | 2013-09-05 |
| 1437438421 | David Lawrence Green | Dentist | 2410 Samson St., Bldg 237, Great Lakes, IL 60088 | 2011-08-09 |
| 1164730602 | James A Lovell Federal Health Care Center | Military/U.S. Coast Guard Pharmacy | 2430 Illinois Street, Great Lakes, IL 60088 | 2010-09-17 |
| 1598073439 | James A Lovell Federal Health Care Center | Military/U.S. Coast Guard Pharmacy | 2430 Illinois St, Bldg 1007, Great Lakes, IL 60088 | 2010-09-14 |
| 1164736302 | Clinton Lariscy | Military Health Care Provider | 3355 Illinois St, Recruit Training Command Great Lakes, Great Lakes, IL 60088 | 2010-07-29 |
| 1083943906 | James Doll | Dentist | 2608 Paul Jones St, Great Lakes, IL 60088 | 2009-12-24 |
| 1396996823 | Kelly Robert Lanning | Dentist | 3001 A 6th St Bhc 237, Naval Hospital Great Lakes- Dental Dept., Great Lakes, IL 60088 | 2008-10-02 |
| Find all providers in zip 60088 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245389329 | Travis Scott Parris | Psychologist | 3420 Illinois St., Naval Health Clinic Great Lakes, Uss Tranquillity, Rmh, Great Lakes, IL 60088-5230 | 2007-01-09 |
| 1245595776 | Alma Teresa C Molino | Psychologist | 3420 Illinois St, Great Lakes, IL 60088-3161 | 2012-07-10 |
| 1134275282 | Faan Yeen Sidor | Psychologist | 3001a Sixth St., Bldg 200h 4e, Great Lakes, IL 60088-2833 | 2007-01-25 |
| 1972524882 | Andrew Joseph Blazsanyik | Psychologist | 3001a Sixth Street, Naval Health Center 9th Floor, Great Lakes, IL 60088-5230 | 2006-07-23 |
| 1013985241 | Carolyn F. Andrews | Psychologist | 3001 6th St Ste A, Naval Health Clinic, Bldg 200-h 9-n Mental Health Cntr, Great Lakes, IL 60088-2833 | 2006-03-14 |
| 1477527059 | Elaine Keefer May | Psychologist | 3001a Sixth Street, Great Lakes, IL 60088-2833 | 2006-02-13 |
| 1205807823 | Douglas Lee Hazen | Psychologist | 3420 Illinois St, Reu - Uss Tranquillity, Great Lakes, IL 60088-3120 | 2006-01-31 |
| 1740251214 | Julie Lynn Ruddy | Psychologist | 3420 Illinois St, Recruit Mental Health, Uss Tranquillity, Great Lakes, IL 60088-3120 | 2006-01-31 |
| 1528042280 | John E. Dalton | Psychologist | 3420 Illinois St, Reu, Building 1007, Great Lakes, IL 60088-3120 | 2005-12-05 |
| 1750365219 | Kevin Potter Brown | Psychologist | 3001 6th St, Great Lakes, IL 60088-2833 | 2005-11-30 |
| Find all providers in GREAT LAKES | ||||
| City | GREAT LAKES |
| Zip Code | 60088 |
Please comment or provide details below to improve the information on DR. JASON TODD HOLDEMAN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.