Provider Demographics
NPI:1548772387
Name:KASPER, WENDY SUE
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:SUE
Last Name:KASPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W8172 COUNTY ROAD B
Mailing Address - Street 2:
Mailing Address - City:LAKE MILLS
Mailing Address - State:WI
Mailing Address - Zip Code:53551-9727
Mailing Address - Country:US
Mailing Address - Phone:920-597-0033
Mailing Address - Fax:608-423-3616
Practice Address - Street 1:W8172 COUNTY ROAD B
Practice Address - Street 2:
Practice Address - City:LAKE MILLS
Practice Address - State:WI
Practice Address - Zip Code:53551-9727
Practice Address - Country:US
Practice Address - Phone:920-597-0033
Practice Address - Fax:608-423-3616
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
82-2932402OtherPERSONAL CARE WORKER