Healthcare Provider Details

I. General information

NPI: 1841613668
Provider Name (Legal Business Name): KASEY BENTHIN-STALEY MSW, LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2014
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 BUCKLICK CREEK RD
MINFORD OH
45653-8882
US

IV. Provider business mailing address

215 BUCKLICK CREEK RD
MINFORD OH
45653-8882
US

V. Phone/Fax

Practice location:
  • Phone: 740-402-1142
  • Fax:
Mailing address:
  • Phone: 740-402-1142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1502319-SUPV
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.1502319-SUPV
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW127042
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: