Healthcare Provider Details

I. General information

NPI: 1851191878
Provider Name (Legal Business Name): ELIZABETH ANNE CASPER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 E WASHINGTON ST STE 3B
BLOOMINGTON IL
61701-4365
US

IV. Provider business mailing address

2906 E COLLEGE AVE
BLOOMINGTON IL
61704-8453
US

V. Phone/Fax

Practice location:
  • Phone: 309-304-3047
  • Fax:
Mailing address:
  • Phone: 309-242-0865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071008594
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number743767
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: