Provider Demographics
NPI:1558636050
Name:KASPER, TAMARA SUE (MS, CCC-SLP, BCBA)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:SUE
Last Name:KASPER
Suffix:
Gender:F
Credentials:MS, CCC-SLP, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-9553
Mailing Address - Country:US
Mailing Address - Phone:262-388-0398
Mailing Address - Fax:262-922-4444
Practice Address - Street 1:388 WOODSIDE DR
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-9553
Practice Address - Country:US
Practice Address - Phone:262-388-0398
Practice Address - Fax:262-922-4444
Is Sole Proprietor?:No
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12-140103K00000X
WI562-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42707800Medicaid