Provider Demographics
NPI:1104617356
Name:HOLLAND, SUSAN M (NBC-HWC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:679 SE 11TH ST
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:OR
Mailing Address - Zip Code:97115-9604
Mailing Address - Country:US
Mailing Address - Phone:503-330-3187
Mailing Address - Fax:
Practice Address - Street 1:679 SE 11TH ST
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:OR
Practice Address - Zip Code:97115-9604
Practice Address - Country:US
Practice Address - Phone:503-330-3187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA-4046440171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach