Healthcare Provider Details

I. General information

NPI: 1962488247
Provider Name (Legal Business Name): LINDA MARLENE KASTELOWITZ PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 S 4TH ST W
MISSOULA MT
59801-2629
US

IV. Provider business mailing address

PO BOX 7275
MISSOULA MT
59807-7275
US

V. Phone/Fax

Practice location:
  • Phone: 406-327-8830
  • Fax: 406-549-2151
Mailing address:
  • Phone: 406-327-8830
  • Fax: 406-549-2151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number304
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: