Healthcare Provider Details

I. General information

NPI: 1306305255
Provider Name (Legal Business Name): KAREN QUALE KAUL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E FRTH PLN BLVD
VANCOUVER WA
98661-3713
US

IV. Provider business mailing address

1601 E FRTH PLN BLVD
VANCOUVER WA
98661-3713
US

V. Phone/Fax

Practice location:
  • Phone: 503-314-6743
  • Fax: 360-690-0343
Mailing address:
  • Phone: 503-314-6743
  • Fax: 360-690-0343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL2756
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: