Provider Demographics
NPI:1457450942
Name:HOLLAND, MERLE S (EDD)
Entity Type:Individual
Prefix:DR
First Name:MERLE
Middle Name:S
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2651 N. MAGNOLIA AVE.
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1213
Mailing Address - Country:US
Mailing Address - Phone:773-935-0668
Mailing Address - Fax:
Practice Address - Street 1:2651 N. MAGNOLIA AVE.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614
Practice Address - Country:US
Practice Address - Phone:312-515-9423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007610103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1600869OtherBLUE CROSS BLUE SHIELD OF ILLINOIS