Healthcare Provider Details

I. General information

NPI: 1386505725
Provider Name (Legal Business Name): KASIE RIDGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 LIBRARY BLVD STE A
GREENWOOD IN
46142-1567
US

IV. Provider business mailing address

1701 LIBRARY BLVD STE A
GREENWOOD IN
46142-1567
US

V. Phone/Fax

Practice location:
  • Phone: 317-881-9923
  • Fax: 317-881-9966
Mailing address:
  • Phone: 317-881-9923
  • Fax: 317-881-9966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: