Individual
MS. KATHLEEN RENEE MAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
113 LINCOLNWAY E, MISHAWAKA, IN 46544-2016
(574) 255-4976
Mailing address
PO BOX 1887, ELKHART, IN 46515-1887
(574) 389-0542
(574) 522-8505
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34001414A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000391927
ANTHEM BCBS #
IN
Enumeration date
03/14/2006
Last updated
01/22/2020
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