1326211731 NPI number — DR. KIMBERLY COLE PSY. D.

Table of content: (NPI 1881714772)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326211731 NPI number — DR. KIMBERLY COLE PSY. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLE
Provider First Name:
KIMBERLY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY. D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326211731
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14304 E 10TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPOKANE VALLEY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99037-9648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-496-2857
Provider Business Mailing Address Fax Number:
509-315-5048

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 N JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEDICAL LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99022-9613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-496-2857
Provider Business Practice Location Address Fax Number:
509-315-5048
Provider Enumeration Date:
04/07/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PY00003698 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7142250 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".