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General NPI Number Information
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NPI Number | 1891085643
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Entity Type | Organization
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Legal Business Name | DIANE KAISER PSYD
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Dates
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Enumeration Date | 04/13/2011
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Last Update Date | 08/03/2011
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Provider Practice Location Address
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Address Line | 108 SE 124TH AVE
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City | VANCOUVER
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State | WA
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Zip | 98684-6015
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Country | US
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Telephone | 360-524-5200
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Fax | 360-694-1828
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Provider Business Mailing Address
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Address Line | 512 NE 81ST ST STE F BOX 311
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City | VANCOUVER
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State | WA
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Zip | 98665-8134
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Country | US
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Telephone | 360-524-5200
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Fax | 360-694-1828
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Authorized Official
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Title or Position | PRESIDENT
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Name | DIANE S KAISER
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Credential | PSY.D
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Telephone | 360-524-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY00002519
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License Number State | WA
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