Provider Demographics
NPI:1699092924
Name:HOLGATE, MAGEN MALEAH (MSW, LICSW)
Entity type:Individual
Prefix:MRS
First Name:MAGEN
Middle Name:MALEAH
Last Name:HOLGATE
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942-1227
Mailing Address - Country:US
Mailing Address - Phone:509-833-6669
Mailing Address - Fax:
Practice Address - Street 1:5 S 8TH ST
Practice Address - Street 2:
Practice Address - City:SELAH
Practice Address - State:WA
Practice Address - Zip Code:98942-1227
Practice Address - Country:US
Practice Address - Phone:509-833-6669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW604217481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical