Individual
KACY GAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2505 E JEFFERSON BLVD, SOUTH BEND, IN 46615-2635
(574) 289-4831
Mailing address
1319 VIKING DR, SOUTH BEND, IN 46628-3838
(574) 520-8507
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
05/05/2022
Last updated
05/05/2022
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