Provider Demographics
NPI:1194559377
Name:KUSTER, STACIE L (LMSW)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:L
Last Name:KUSTER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 DES MOINES AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-4444
Mailing Address - Country:US
Mailing Address - Phone:319-209-2084
Mailing Address - Fax:319-209-2086
Practice Address - Street 1:2115 DES MOINES AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-4444
Practice Address - Country:US
Practice Address - Phone:319-209-2084
Practice Address - Fax:319-209-2086
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA123772104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker