Provider Demographics
NPI:1205320462
Name:KASTEN, COLLEEN LYNN (SACIT)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:LYNN
Last Name:KASTEN
Suffix:
Gender:F
Credentials:SACIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1971 WASHINGTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-2125
Mailing Address - Country:US
Mailing Address - Phone:262-377-6276
Mailing Address - Fax:262-377-6289
Practice Address - Street 1:1971 WASHINGTON ST STE 200
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-2125
Practice Address - Country:US
Practice Address - Phone:262-377-6276
Practice Address - Fax:262-377-6289
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18529-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)