Provider Demographics
NPI:1891085643
Name:DIANE KAISER PSYD
Entity type:Organization
Organization Name:DIANE KAISER PSYD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:S
Authorized Official - Last Name:KAISER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:360-524-5200
Mailing Address - Street 1:512 NE 81ST ST
Mailing Address - Street 2:STE F BOX 311
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8134
Mailing Address - Country:US
Mailing Address - Phone:360-524-5200
Mailing Address - Fax:360-694-1828
Practice Address - Street 1:108 SE 124TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6015
Practice Address - Country:US
Practice Address - Phone:360-524-5200
Practice Address - Fax:360-694-1828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002519103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty