Provider Demographics
NPI:1326211731
Name:COLE, KIMBERLY (PSY D)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14304 E 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99037-9648
Mailing Address - Country:US
Mailing Address - Phone:509-496-2857
Mailing Address - Fax:509-315-5048
Practice Address - Street 1:108 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MEDICAL LAKE
Practice Address - State:WA
Practice Address - Zip Code:99022-9613
Practice Address - Country:US
Practice Address - Phone:509-496-2857
Practice Address - Fax:509-315-5048
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003698103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7142250Medicaid