Individual
KASIE WISTAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12409 W INDIAN SCHOOL RD STE B210, AVONDALE, AZ 85392-9505
(855) 223-7123
Mailing address
PO BOX 740780, ATLANTA, GA 30374-0780
(855) 223-7123
(855) 223-7123
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
02/10/2026
Last updated
02/10/2026
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