Healthcare Provider Details

I. General information

NPI: 1255995718
Provider Name (Legal Business Name): STEPHANIE CASEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 03/05/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 N M 129
PICKFORD MI
49774-9204
US

IV. Provider business mailing address

416 N M 129
PICKFORD MI
49774-9204
US

V. Phone/Fax

Practice location:
  • Phone: 906-647-2217
  • Fax: 906-647-2228
Mailing address:
  • Phone: 906-647-2217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801094018
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: