Provider Demographics
NPI:1053593988
Name:KASTER, JESSE C (BC HIS)
Entity type:Individual
Prefix:MR
First Name:JESSE
Middle Name:C
Last Name:KASTER
Suffix:
Gender:
Credentials:BC HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 W MASON ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-2331
Mailing Address - Country:US
Mailing Address - Phone:920-212-7660
Mailing Address - Fax:920-212-7659
Practice Address - Street 1:1780 W MASON ST STE A
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-2331
Practice Address - Country:US
Practice Address - Phone:920-212-7660
Practice Address - Fax:920-212-7659
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1229-060237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42837100Medicaid