Basic Information
| Provider Information | |||||||||
| NPI: | 1255995718 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASEY | ||||||||
| FirstName: | STEPHANIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 416 N M 129 | ||||||||
| Address2: | |||||||||
| City: | PICKFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497749204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9066472217 | ||||||||
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| Practice Location | |||||||||
| Address1: | 416 N M 129 | ||||||||
| Address2: | |||||||||
| City: | PICKFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497749204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9066472217 | ||||||||
| FaxNumber: | 9066472228 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2019 | ||||||||
| LastUpdateDate: | 03/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801094018 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.