Healthcare Provider Details

I. General information

NPI: 1821211228
Provider Name (Legal Business Name): PAUL J KALLMANN MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 NE OAK VIEW DR
VANCOUVER WA
98662-6347
US

IV. Provider business mailing address

9211 NE 15TH AVE
VANCOUVER WA
98665-9126
US

V. Phone/Fax

Practice location:
  • Phone: 360-213-2449
  • Fax: 360-567-2212
Mailing address:
  • Phone: 360-213-3679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberRC00051486
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: