Healthcare Provider Details

I. General information

NPI: 1750638110
Provider Name (Legal Business Name): BOBBI E KIZER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BOBBY E KIZER PHD

II. Dates (important events)

Enumeration Date: 08/04/2012
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4219 E PRAIRIE LANE CT
SPOKANE WA
99223
US

IV. Provider business mailing address

4219 E PRAIRIE LANE CT
SPOKANE WA
99223-6025
US

V. Phone/Fax

Practice location:
  • Phone: 504-390-5782
  • Fax:
Mailing address:
  • Phone: 504-390-5782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: