Healthcare Provider Details

I. General information

NPI: 1457277089
Provider Name (Legal Business Name): KALIE MICHELLE DYKSTERHOUSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 CORNWALL AVE STE 200
BELLINGHAM WA
98225-4733
US

IV. Provider business mailing address

1610 J ST APT 203
BELLINGHAM WA
98225-3084
US

V. Phone/Fax

Practice location:
  • Phone: 360-300-2123
  • Fax:
Mailing address:
  • Phone: 614-601-3619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: