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General NPI Number Information
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NPI Number | 1174949598
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Entity Type | Individual
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Provider Name | KENDALL PAULINE HAGENSEN LMHCA
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Gender | Female
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Dates
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Enumeration Date | 03/10/2014
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Last Update Date | 10/02/2016
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Provider Practice Location Address
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Address Line | 800 FRANKLIN ST #200
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City | VANCOUVER
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State | WA
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Zip | 98660-3355
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Country | US
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Telephone | 360-904-9432
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Fax |
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Provider Business Mailing Address
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Address Line | 321 W 37TH ST
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City | VANCOUVER
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State | WA
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Zip | 98660-1945
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Country | US
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Telephone | 360-904-9432
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | NLC.0104228
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MC60485464
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License Number State | WA
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