Provider Demographics
NPI:1730898685
Name:DOUGAL, KELLI MICHELLE (MSW)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:MICHELLE
Last Name:DOUGAL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:
Other - Last Name:FIELDING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:712 NE 138TH PL
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-4604
Mailing Address - Country:US
Mailing Address - Phone:360-921-4263
Mailing Address - Fax:
Practice Address - Street 1:2500 NE 65TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-6812
Practice Address - Country:US
Practice Address - Phone:360-952-3644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker