| Doctor Name: | KASANDRA STARK |
| NPI Number: | 1053749630 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 104 S.w. Kinkade Rd Boardman, OR - 97818 |
| Business Phone Number: | 5414812911 |
| Business Fax Number: | |
| Mailing Address: | Po Box 261, BOARDMAN |
| State: | OR |
| Postal Code: | 978180261 |
| Phone Number: | 5414812911 |
| Fax Number: | |
| NPI Enumeration Date: | 10/17/2013 |
| NPI Last Update Date: | 10/17/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |