Individual
JASON HOLLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1007 KOALA DR, OMAK, WA 98841-9247
(509) 826-6191
Mailing address
1007 KOALA DR, OMAK, WA 98841-9247
(509) 826-6191
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1090983
—
WA
Enumeration date
05/31/2022
Last updated
05/31/2022
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