Provider Demographics
NPI:1538698147
Name:KOLPAK, STANLEY D II (PHD)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:D
Last Name:KOLPAK
Suffix:II
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:ELMA
Mailing Address - State:WA
Mailing Address - Zip Code:98541-9330
Mailing Address - Country:US
Mailing Address - Phone:360-470-4277
Mailing Address - Fax:360-532-8786
Practice Address - Street 1:604 N 13TH ST
Practice Address - Street 2:
Practice Address - City:ELMA
Practice Address - State:WA
Practice Address - Zip Code:98541-9330
Practice Address - Country:US
Practice Address - Phone:360-470-4277
Practice Address - Fax:360-532-8786
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF61513857106H00000X
WALH1211688101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist