Provider Demographics
NPI:1497927396
Name:KASTEN, JACKIE L (LPC)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:L
Last Name:KASTEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 SW ALDER ST
Mailing Address - Street 2:SUITE 520
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-3626
Mailing Address - Country:US
Mailing Address - Phone:503-494-4745
Mailing Address - Fax:503-494-4747
Practice Address - Street 1:621 SW ALDER ST
Practice Address - Street 2:SUITE 520
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-3626
Practice Address - Country:US
Practice Address - Phone:503-494-4745
Practice Address - Fax:503-494-4747
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1944101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional