Healthcare Provider Details

I. General information

NPI: 1962856195
Provider Name (Legal Business Name): MISS CASEY M VIEAU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 10/29/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W LAKE ST STE 204
CHISHOLM MN
55719-1818
US

IV. Provider business mailing address

302 E HOWARD ST STE 327
HIBBING MN
55746-1772
US

V. Phone/Fax

Practice location:
  • Phone: 218-235-1703
  • Fax: 218-249-1559
Mailing address:
  • Phone: 218-235-1703
  • Fax: 218-440-1278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: