Provider Demographics
NPI:1487922498
Name:SUDA, HOLLY MARIE (MSCCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:HOLLY
Middle Name:MARIE
Last Name:SUDA
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4123 SE 33RD PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3444
Mailing Address - Country:US
Mailing Address - Phone:503-758-6978
Mailing Address - Fax:
Practice Address - Street 1:4123 SE 33RD PL
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-3444
Practice Address - Country:US
Practice Address - Phone:503-758-6978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13436235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist