Provider Demographics
NPI:1497280069
Name:HOLIDAY, RIANN ASHLEE
Entity Type:Individual
Prefix:MRS
First Name:RIANN
Middle Name:ASHLEE
Last Name:HOLIDAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-2642
Mailing Address - Country:US
Mailing Address - Phone:303-902-2823
Mailing Address - Fax:
Practice Address - Street 1:1257 LAKE PLAZA DR STE 205
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3577
Practice Address - Country:US
Practice Address - Phone:719-375-2955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COBACB375993106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician