Provider Demographics
NPI:1568688646
Name:ISLAM-ZWART, KAYLEEN (PHD)
Entity Type:Individual
Prefix:
First Name:KAYLEEN
Middle Name:
Last Name:ISLAM-ZWART
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KAYLEEN
Other - Middle Name:
Other - Last Name:CULBERTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, MS
Mailing Address - Street 1:140 S ARTHUR ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2204
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 S ARTHUR ST STE 410
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2220
Practice Address - Country:US
Practice Address - Phone:509-456-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003287103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical