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General NPI Number Information
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NPI Number | 1053422014
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Entity Type | Individual
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Provider Name | CAROL ANN PAHLKE PHD
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 11/16/2011
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Provider Practice Location Address
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Address Line | 945 11TH AVE #B
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City | LONGVIEW
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State | WA
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Zip | 98632
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Country | US
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Telephone | 360-414-8600
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Fax | 360-636-7372
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Provider Business Mailing Address
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Address Line | 945 11TH AVE #B
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City | LONGVIEW
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State | WA
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Zip | 98632
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Country | US
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Telephone | 360-414-8600
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Fax | 360-636-7372
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY1687
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License Number State | WA
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