Provider Demographics
NPI:1023534658
Name:BIRKELAND, KAYLA DIANE (MA)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:DIANE
Last Name:BIRKELAND
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15609 SE MILL PLAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-8952
Mailing Address - Country:US
Mailing Address - Phone:360-215-3242
Mailing Address - Fax:360-326-7224
Practice Address - Street 1:15609 SE MILL PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-8952
Practice Address - Country:US
Practice Address - Phone:360-215-3242
Practice Address - Fax:360-326-7224
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61277365101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2097582Medicaid