Provider Demographics
NPI:1053489575
Name:HOLLIDAY, SUSAN R (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:R
Last Name:HOLLIDAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:BURCHFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:3909 NE SURBER DR
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-5406
Mailing Address - Country:US
Mailing Address - Phone:206-499-3913
Mailing Address - Fax:206-523-6809
Practice Address - Street 1:4026 NE 55TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-2254
Practice Address - Country:US
Practice Address - Phone:206-526-8711
Practice Address - Fax:206-523-6809
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00000960103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA217000196Medicare ID - Type Unspecified