Provider Demographics
NPI:1427308436
Name:HOLLAND, MARYJANE (MS, SLP-CCC)
Entity type:Individual
Prefix:
First Name:MARYJANE
Middle Name:
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:MS, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 NW 199TH ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-5601
Mailing Address - Country:US
Mailing Address - Phone:360-619-1500
Mailing Address - Fax:360-619-1559
Practice Address - Street 1:502 NW 199TH ST
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:WA
Practice Address - Zip Code:98642-5601
Practice Address - Country:US
Practice Address - Phone:360-619-1500
Practice Address - Fax:360-619-1559
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD12086484OtherASHA