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General NPI Number Information
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NPI Number | 1053489575
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Entity Type | Individual
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Provider Name | SUSAN R HOLLIDAY PHD
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Gender | Female
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 11/01/2016
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Provider Practice Location Address
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Address Line | 4026 NE 55TH ST SUITE B
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City | SEATTLE
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State | WA
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Zip | 98105-2254
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Country | US
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Telephone | 206-526-8711
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Fax | 206-523-6809
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Provider Business Mailing Address
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Address Line | 3909 NE SURBER DR
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City | SEATTLE
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State | WA
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Zip | 98105-5406
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Country | US
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Telephone | 206-499-3913
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Fax | 206-523-6809
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY00000960
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License Number State | WA
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