MEDICARE: MRS. CASEY L WYMAN M.S., LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	CC00672	MN
2	101YP2500X	Professional Counselor	CC00672	MN

General Provider Information

NPI Number	:	1568892644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CASEY L WYMAN M.S., LPCC

Provider Business Mailing Address
First Line	:	118 AVENUE C
Second Line	:
City	:	CLOQUET
State	:	MN
Zip	:	55720-1546
Country	:	US
Telephone Number	:	218-341-9632
Fax Number	:

Provider Business Practice Location Address
First Line	:	118 AVENUE C
Second Line	:
City	:	CLOQUET
State	:	MN
Zip	:	55720-1546
Country	:	US
Telephone Number	:	218-878-9352
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/26/2013
Last Update Date	:	01/25/2024

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