Provider Demographics
NPI:1295850022
Name:KUSTER, CAROL LEE (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:LEE
Last Name:KUSTER
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19650 CHIMO WEST ST
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-3507
Mailing Address - Country:US
Mailing Address - Phone:952-475-9070
Mailing Address - Fax:
Practice Address - Street 1:19650 CHIMO WEST ST
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-3507
Practice Address - Country:US
Practice Address - Phone:952-475-9070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4175103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical