Healthcare Provider Details

I. General information

NPI: 1881788842
Provider Name (Legal Business Name): CASEY SMITH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 BARNETTE STREET
FAIRBANKS AK
99701
US

IV. Provider business mailing address

510 YAK RD. 857 D
FAIRBANKS AK
99709
US

V. Phone/Fax

Practice location:
  • Phone: 907-456-4729
  • Fax: 907-456-4623
Mailing address:
  • Phone: 907-374-5957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2026
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: