Provider Demographics
NPI:1699560714
Name:KASTNER, REBECCA M (PHD, LP, ABPP)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:M
Last Name:KASTNER
Suffix:
Gender:
Credentials:PHD, LP, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 WAYZATA BLVD E
Mailing Address - Street 2:STE 1 PMB 5064
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1250 WAYZATA BLVD E
Practice Address - Street 2:STE 1 PMB 5064
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391
Practice Address - Country:US
Practice Address - Phone:612-930-2838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6064103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic