Provider Demographics
NPI:1538698147
Name:KOLPAK, STAN DEAN II (BS, CAAR)
Entity Type:Individual
Prefix:MR
First Name:STAN
Middle Name:DEAN
Last Name:KOLPAK
Suffix:II
Gender:M
Credentials:BS, CAAR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 8TH ST
Mailing Address - Street 2:
Mailing Address - City:HOQUIAM
Mailing Address - State:WA
Mailing Address - Zip Code:98550-2507
Mailing Address - Country:US
Mailing Address - Phone:360-532-8629
Mailing Address - Fax:360-532-8786
Practice Address - Street 1:205 8TH ST
Practice Address - Street 2:
Practice Address - City:HOQUIAM
Practice Address - State:WA
Practice Address - Zip Code:98550-2507
Practice Address - Country:US
Practice Address - Phone:360-532-8629
Practice Address - Fax:360-532-8786
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60744852101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health