Provider Demographics
NPI:1780702464
Name:KAHLE, SVETLANA (PSYD)
Entity type:Individual
Prefix:DR
First Name:SVETLANA
Middle Name:
Last Name:KAHLE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 WISCONSIN AVENUE
Mailing Address - Street 2:WALTER REED NATIONAL MILITARY MEDICAL CENTER
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20414
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4494 N PALMER RD
Practice Address - Street 2:BLDG. 1 ROOM 8120
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-0001
Practice Address - Country:US
Practice Address - Phone:301-312-3705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016976103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OPTIONALMedicare UPIN