Provider Demographics
NPI:1811929268
Name:KAST, AUDREY C (PHD)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:C
Last Name:KAST
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:C
Other - Last Name:DSOUZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:3398 E MARIA DR
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-1362
Mailing Address - Country:US
Mailing Address - Phone:715-341-7441
Mailing Address - Fax:
Practice Address - Street 1:3398 E MARIA DR
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-1362
Practice Address - Country:US
Practice Address - Phone:715-341-7441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1413057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R54434Medicare UPIN
000088118Medicare ID - Type Unspecified