Provider Demographics
NPI:1962488247
Name:KASTELOWITZ, LINDA MARLENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:MARLENE
Last Name:KASTELOWITZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7275
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59807-7275
Mailing Address - Country:US
Mailing Address - Phone:406-327-8830
Mailing Address - Fax:406-549-2151
Practice Address - Street 1:519 S 4TH ST W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-2629
Practice Address - Country:US
Practice Address - Phone:406-327-8830
Practice Address - Fax:406-549-2151
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT304103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0490110Medicaid