Provider Demographics
NPI:1205152949
Name:KIDO PSYCHOLOGICAL SERVICES PS
Entity type:Organization
Organization Name:KIDO PSYCHOLOGICAL SERVICES PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOHNS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:360-608-9311
Mailing Address - Street 1:9013 NE HIGHWAY 99 STE R
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8943
Mailing Address - Country:US
Mailing Address - Phone:360-773-9121
Mailing Address - Fax:360-314-4051
Practice Address - Street 1:9013 NE HIGHWAY 99 STE R
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8943
Practice Address - Country:US
Practice Address - Phone:360-773-9121
Practice Address - Fax:360-314-4051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1936251S00000X
WAPY60015408251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8876545OtherMEDICARE PART B