Provider Demographics
NPI:1619021805
Name:KOLSTAD, LINDA GAYLE (PHD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:GAYLE
Last Name:KOLSTAD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 S MILPITAS BLVD
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-5473
Mailing Address - Country:US
Mailing Address - Phone:408-945-5082
Mailing Address - Fax:408-945-5007
Practice Address - Street 1:611 S MILPITAS BLVD
Practice Address - Street 2:ADULT PSYCHIATRY
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-5473
Practice Address - Country:US
Practice Address - Phone:408-945-5082
Practice Address - Fax:408-945-5007
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17681103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical