Individual
KENNETH DAVID HOLLADAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9830 NE CASCADES PKWY, SUITE 200, PORTLAND, OR 97220-6832
(503) 239-8101
Mailing address
9830 NE CASCADES PKWY, SUITE 200, PORTLAND, OR 97220-6832
(503) 239-8101
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
156792
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20861000
AETNA
—
01
—
239264
COMPSYCH
—
01
—
421545189
BC
AK
05
—
MD24422
—
AK
05
—
MH9931
—
AK
Enumeration date
10/04/2006
Last updated
02/26/2013
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