Provider Demographics
NPI:1265793723
Name:KINNEAR, ELGA (PSYD)
Entity type:Individual
Prefix:
First Name:ELGA
Middle Name:
Last Name:KINNEAR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ELGA
Other - Middle Name:
Other - Last Name:COCOLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1019 21ST STREET
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221
Mailing Address - Country:US
Mailing Address - Phone:206-321-9391
Mailing Address - Fax:360-299-4372
Practice Address - Street 1:1019 21ST STREET
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221
Practice Address - Country:US
Practice Address - Phone:206-321-9391
Practice Address - Fax:360-299-4372
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60263822103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical