Provider Demographics
NPI:1053813519
Name:FLORA-HOLMQUIST, JADE AUTUMN (LCSW)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:AUTUMN
Last Name:FLORA-HOLMQUIST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9313
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60598-9313
Mailing Address - Country:US
Mailing Address - Phone:267-807-0419
Mailing Address - Fax:616-259-4214
Practice Address - Street 1:3900 GABRIELLE LN UNIT 9313
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60598-4341
Practice Address - Country:US
Practice Address - Phone:267-807-0419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC060874001041C0700X
MI68011189891041C0700X
PACW0224821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical