MEDICARE: KASHA SARAH KILEY CASI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	13520	CA

General Provider Information

NPI Number	:	1750709499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASHA SARAH KILEY CASI

Provider Business Mailing Address
First Line	:	103 PROVIDENCE MINE RD
Second Line	:	SUITE 101
City	:	NEVADA CITY
State	:	CA
Zip	:	95959-2941
Country	:	US
Telephone Number	:	530-265-2914
Fax Number	:	530-265-2974

Provider Business Practice Location Address
First Line	:	103 PROVIDENCE MINE RD
Second Line	:	SUITE 101
City	:	NEVADA CITY
State	:	CA
Zip	:	95959-2941
Country	:	US
Telephone Number	:	530-265-2914
Fax Number	:	530-265-2974

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2014
Last Update Date	:	03/31/2014

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