MEDICARE: KENNETH DAVID HOLLADAY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	156792	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20861000	OTHER		AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	421545189	OTHER	AK	BC
5	239264	OTHER		COMPSYCH

General Provider Information

NPI Number	:	1275628380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH DAVID HOLLADAY M.D.

Provider Business Mailing Address
First Line	:	9830 NE CASCADES PKWY
Second Line	:	SUITE 200
City	:	PORTLAND
State	:	OR
Zip	:	97220-6832
Country	:	US
Telephone Number	:	503-239-8101
Fax Number	:

Provider Business Practice Location Address
First Line	:	9830 NE CASCADES PKWY
Second Line	:	SUITE 200
City	:	PORTLAND
State	:	OR
Zip	:	97220-6832
Country	:	US
Telephone Number	:	503-239-8101
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	02/26/2013

Similar Medicare Providers

1124381330 — MR. BRYAN LEDBURY
Practice Location Address:

9830 NE CASCADES PKWY , STE 200
PORTLAND, OR
97220-6832

Practice Phone: 503-901-7357
Practice Fax:

1487968145 — MS. SHANNON MICHELLE MADSEN M.A.
Practice Location Address:

9830 NE CASCADES PKWY , STE. 200
PORTLAND, OR
97220-6832

Practice Phone: 503-400-0654
Practice Fax:

1538475652 — MRS. MARISSA A. PALMER MSW, LCSW
Practice Location Address:

9830 NE CASCADES PKWY , SUITE 200
PORTLAND, OR
97220-6832

Practice Phone: 503-239-8101
Practice Fax: 503-408-5021

1285943985 — DIANE E PONDER LCSW
Practice Location Address:

9830 NE CASCADES PKWY , SUITE 200
PORTLAND, OR
97220-6832

Practice Phone: 503-239-8101
Practice Fax: 503-239-8106

1407148174 — MR. ALEXANDER DIONYSIOS PLATANIAS
Practice Location Address:

9830 NE CASCADES PKWY , STE 200
PORTLAND, OR
97220-6832

Practice Phone: 503-939-0725
Practice Fax:

1700179769 — THEODORE LAYMAN LCSW
Practice Location Address:

9830 NE CASCADES PKWY , SUITE 200
PORTLAND, OR
97220-6832

Practice Phone: 503-408-5087
Practice Fax:

Directions to “ KENNETH DAVID HOLLADAY M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.