Provider Demographics
NPI:1811134554
Name:SPAYDE, HOLLY L (LSW)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:L
Last Name:SPAYDE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4615 HILTON CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-4151
Mailing Address - Country:US
Mailing Address - Phone:614-729-2024
Mailing Address - Fax:
Practice Address - Street 1:4615 HILTON CORPORATE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4151
Practice Address - Country:US
Practice Address - Phone:614-729-2024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS 0800520104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker