Provider Demographics
NPI:1447238381
Name:HOLLIDGE, COLIN (PHD LISCW)
Entity Type:Individual
Prefix:DR
First Name:COLIN
Middle Name:
Last Name:HOLLIDGE
Suffix:
Gender:M
Credentials:PHD LISCW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4555 ERIN DR
Mailing Address - Street 2:SUITE 260
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-3398
Mailing Address - Country:US
Mailing Address - Phone:651-686-8818
Mailing Address - Fax:
Practice Address - Street 1:4555 ERIN DR
Practice Address - Street 2:SUITE 260
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-3398
Practice Address - Country:US
Practice Address - Phone:651-686-8818
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13587104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN800001332Medicare ID - Type Unspecified