Healthcare Provider Details

I. General information

NPI: 1639173479
Provider Name (Legal Business Name): CHRISTEN A. KISHEL PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 11/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S JEFFERSON ST STE 318
SPOKANE WA
99204-3143
US

IV. Provider business mailing address

2351 S SOUTHEAST BLVD APT 1
SPOKANE WA
99203-7419
US

V. Phone/Fax

Practice location:
  • Phone: 509-993-8301
  • Fax: 509-474-0927
Mailing address:
  • Phone: 509-993-8301
  • Fax: 509-474-0927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY00002917
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY2917
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: