Provider Demographics
NPI:1144556457
Name:KRZYANIAK, HOLLY (LMSW, CSWA)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:KRZYANIAK
Suffix:
Gender:F
Credentials:LMSW, CSWA
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:BORCHARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1660 OAK ST SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-6942
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1660 OAK ST SE
Practice Address - Street 2:SUITE 100
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-6942
Practice Address - Country:US
Practice Address - Phone:503-319-7485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-21
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORM5055104100000X
ORA5055104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker