Provider Demographics
NPI:1407672769
Name:KASTELIC, OLIVIA (LISW-S)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:KASTELIC
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:482 COURTLAND TER
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-5113
Mailing Address - Country:US
Mailing Address - Phone:419-961-7174
Mailing Address - Fax:
Practice Address - Street 1:940 MARION WILLIAMSPORT RD E
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-8256
Practice Address - Country:US
Practice Address - Phone:740-251-5801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.2304771-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical