Individual
KRISTIN LIDVALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTD
Contact information
Practice address
1500 3RD AVE, LONGVIEW, WA 98632-3229
(360) 423-8800
Mailing address
3501 COLUMBIA ST, VANCOUVER, WA 98660-1925
(865) 850-5944
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OT 60291976
WA
Other
Enumeration date
09/30/2013
Last updated
09/30/2013
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