Provider Demographics
NPI:1770318818
Name:CARSTENS, JODIE
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:
Last Name:CARSTENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JODIE
Other - Middle Name:
Other - Last Name:MONGEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:2159 HIGHWAY 183
Mailing Address - Street 2:
Mailing Address - City:GLADE
Mailing Address - State:KS
Mailing Address - Zip Code:67639-3900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:875 3RD ST
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:KS
Practice Address - Zip Code:67661-1612
Practice Address - Country:US
Practice Address - Phone:785-252-7529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10069104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker