Provider Demographics
NPI:1053422014
Name:PAHLKE, CAROL ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANN
Last Name:PAHLKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 11TH AVE
Mailing Address - Street 2:#B
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632
Mailing Address - Country:US
Mailing Address - Phone:360-414-8600
Mailing Address - Fax:360-636-7372
Practice Address - Street 1:945 11TH AVE
Practice Address - Street 2:#B
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632
Practice Address - Country:US
Practice Address - Phone:360-414-8600
Practice Address - Fax:360-636-7372
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY1687103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8921392OtherCRIME VICTIMS
WA98632A009OtherTRECARE
R31575Medicare UPIN
WAAB09112Medicare ID - Type Unspecified