Provider Demographics
NPI:1316192156
Name:WIKSELL, KARA M (MA)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:M
Last Name:WIKSELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:M
Other - Last Name:PESTANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 484
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98666-0484
Mailing Address - Country:US
Mailing Address - Phone:360-699-2244
Mailing Address - Fax:360-699-1900
Practice Address - Street 1:415 W 11TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3147
Practice Address - Country:US
Practice Address - Phone:360-699-2244
Practice Address - Fax:360-699-1900
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health