Healthcare Provider Details

I. General information

NPI: 1528549029
Provider Name (Legal Business Name): CALLEAGHN B KINNAMON PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2018
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 E VICTOR ST APT 2
BELLINGHAM WA
98225-1651
US

IV. Provider business mailing address

1315 E VICTOR ST APT 2
BELLINGHAM WA
98225-1651
US

V. Phone/Fax

Practice location:
  • Phone: 707-267-0449
  • Fax:
Mailing address:
  • Phone: 707-267-0449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSYC.PY.61602270
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: