Provider Demographics
NPI:1225171721
Name:OLTMAN, HOLLY LEEANN (BA)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:LEEANN
Last Name:OLTMAN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:LEEANN
Other - Last Name:MCCLURE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:621 W MADRONE ST
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-3090
Mailing Address - Country:US
Mailing Address - Phone:154-144-0353
Mailing Address - Fax:541-440-3554
Practice Address - Street 1:621 W MADRONE ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-3090
Practice Address - Country:US
Practice Address - Phone:154-144-0353
Practice Address - Fax:541-440-3554
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500663594Medicaid