Doctor Name: | DR. JACK KASL |
NPI Number: | 1174614150 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | LP1955 |
Business Practice Address: | 1790 11th St Se Forest Lake, MN - 550251968 |
Business Phone Number: | 6128678451 |
Business Fax Number: | 7635520787 |
Mailing Address: | 3095 Norway Cir S, CAMBRIDGE |
State: | MN |
Postal Code: | 550082670 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 09/27/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | LP1955 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |