Provider Demographics
NPI:1750805032
Name:HOLLEY, BRIANNE KATHRYN (LHIS)
Entity type:Individual
Prefix:
First Name:BRIANNE
Middle Name:KATHRYN
Last Name:HOLLEY
Suffix:
Gender:F
Credentials:LHIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8703 NE 37TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-7548
Mailing Address - Country:US
Mailing Address - Phone:360-356-8656
Mailing Address - Fax:
Practice Address - Street 1:11516 SE MILL PLAIN BLVD STE J2
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5082
Practice Address - Country:US
Practice Address - Phone:360-882-8027
Practice Address - Fax:360-882-8030
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA60764249237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist