Provider Demographics
NPI:1548054182
Name:GAUCK, KYRSTEN (BSW)
Entity type:Individual
Prefix:
First Name:KYRSTEN
Middle Name:
Last Name:GAUCK
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 CAVALIER BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-3952
Mailing Address - Country:US
Mailing Address - Phone:859-594-4510
Mailing Address - Fax:859-594-4519
Practice Address - Street 1:75 CAVALIER BLVD STE 110
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-3952
Practice Address - Country:US
Practice Address - Phone:859-594-4510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator