Provider Demographics
NPI:1659907764
Name:KIZER, BELINDA DAWN
Entity Type:Individual
Prefix:
First Name:BELINDA
Middle Name:DAWN
Last Name:KIZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 COOPER POINT RD SW STE 21
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-1179
Mailing Address - Country:US
Mailing Address - Phone:360-810-1547
Mailing Address - Fax:
Practice Address - Street 1:111 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-1108
Practice Address - Country:US
Practice Address - Phone:002-236-0240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB61048721106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician