Healthcare Provider Details

I. General information

NPI: 1225528946
Provider Name (Legal Business Name): KRISTINA LYNN DUKART LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6715 NE 63RD ST STE 103 PMB 162
VANCOUVER WA
98661
US

IV. Provider business mailing address

6715 NE 63RD ST STE 103 PMB 162
VANCOUVER WA
98661
US

V. Phone/Fax

Practice location:
  • Phone: 360-524-3628
  • Fax:
Mailing address:
  • Phone: 360-524-3628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberL17219
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61463819
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-LCSW-LIC-30555
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: