Healthcare Provider Details

I. General information

NPI: 1578851861
Provider Name (Legal Business Name): CASEY LYNN CRAIG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2011
Last Update Date: 05/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 E COURT ST
PARIS IL
61944
US

IV. Provider business mailing address

PO BOX 1118
PARIS IL
61944-5118
US

V. Phone/Fax

Practice location:
  • Phone: 217-465-4118
  • Fax:
Mailing address:
  • Phone: 217-465-4118
  • Fax: 217-442-7460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149021198
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: