Provider Demographics
NPI:1376809459
Name:KASENCHAK, KATHRYN LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:LYNN
Last Name:KASENCHAK
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 1:15 KANOA ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2426
Mailing Address - Country:US
Mailing Address - Phone:808-345-3058
Mailing Address - Fax:
Practice Address - Street 1:15 KANOA ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2426
Practice Address - Country:US
Practice Address - Phone:808-345-3058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1279103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical