Healthcare Provider Details

I. General information

NPI: 1497529085
Provider Name (Legal Business Name): CASEY MARIE KUTRIP LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 4TH ST
HILLSBORO MO
63050-5043
US

IV. Provider business mailing address

448 WYLIE DR
NORMAL IL
61761-5405
US

V. Phone/Fax

Practice location:
  • Phone: 161-887-7442
  • Fax:
Mailing address:
  • Phone: 618-512-1803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2022030709
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: