Healthcare Provider Details

I. General information

NPI: 1851674519
Provider Name (Legal Business Name): HOLLY ELIZABETH WOODALL M.C.D. CCC-SLP, LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2807 SW BATAAN STREET
SEATTLE WA
98126
US

IV. Provider business mailing address

2807 SW BATAAN STREET
SEATTLE WA
98126
US

V. Phone/Fax

Practice location:
  • Phone: 302-547-1363
  • Fax:
Mailing address:
  • Phone: 302-547-1363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA60330991
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLL60244300
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: