Healthcare Provider Details

I. General information

NPI: 1962572974
Provider Name (Legal Business Name): STEVEN J KUCHTA PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 SOUTH 1ST STREET
WILLMAR MN
56201
US

IV. Provider business mailing address

101 WILLMAR AVE SW
WILLMAR MN
56201
US

V. Phone/Fax

Practice location:
  • Phone: 320-231-5000
  • Fax: 320-231-5067
Mailing address:
  • Phone: 320-231-5079
  • Fax: 320-231-5067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP4496
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: