Basic Information
| Provider Information | |||||||||
| NPI: | 1285824276 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PERSOHN | ||||||||
| FirstName: | CASEY | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1314 E WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 475012860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122542760 | ||||||||
| FaxNumber: | 8122578602 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 NE 14TH ST | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 475012137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122542250 | ||||||||
| FaxNumber: | 8122547884 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2007 | ||||||||
| LastUpdateDate: | 07/29/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 934562 | IN | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.