Healthcare Provider Details

I. General information

NPI: 1609348317
Provider Name (Legal Business Name): KAYLA GILMAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2018
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10604 NE HIGHWAY 99
VANCOUVER WA
98686-5613
US

IV. Provider business mailing address

10604 NE HIGHWAY 99
VANCOUVER WA
98686-5613
US

V. Phone/Fax

Practice location:
  • Phone: 360-644-1631
  • Fax:
Mailing address:
  • Phone: 360-644-1631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: