Provider Demographics
NPI:1487752648
Name:CHOLLMAN, MARY MARGARET (AUD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:MARGARET
Last Name:CHOLLMAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21911 76TH AVE W STE 211
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7918
Mailing Address - Country:US
Mailing Address - Phone:425-775-6651
Mailing Address - Fax:425-670-6718
Practice Address - Street 1:515 MINOR AVE STE 150
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2144
Practice Address - Country:US
Practice Address - Phone:206-622-9916
Practice Address - Fax:206-838-8346
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00002407231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1031201Medicaid