Healthcare Provider Details

I. General information

NPI: 1306325659
Provider Name (Legal Business Name): KATHLYN MARIE HOLLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SW 7TH ST
RENTON WA
98057-2307
US

IV. Provider business mailing address

330 W OLYMPIC PL APT 207
SEATTLE WA
98119-3734
US

V. Phone/Fax

Practice location:
  • Phone: 503-256-6511
  • Fax:
Mailing address:
  • Phone: 253-709-0454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberCB60872217
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number17601
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: