Provider Demographics
NPI:1326871617
Name:HOLTER, SHYANN MCKENNA
Entity type:Individual
Prefix:
First Name:SHYANN
Middle Name:MCKENNA
Last Name:HOLTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHYANN
Other - Middle Name:MCKENNA
Other - Last Name:SIEMIENIEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1470 INDUSTRIAL DR NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-0700
Mailing Address - Country:US
Mailing Address - Phone:507-353-3023
Mailing Address - Fax:
Practice Address - Street 1:1470 INDUSTRIAL DR NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-0700
Practice Address - Country:US
Practice Address - Phone:507-353-3023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician