1295734994 NPI number — JANET E. CASEY MSW, LICSW

Table of content: MRS. DAYAN CARLA BOOKMAN (NPI 1578872867)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295734994 NPI number — JANET E. CASEY MSW, LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASEY
Provider First Name:
JANET
Provider Middle Name:
E.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295734994
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 352
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BECKER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55308-0352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-743-3639
Provider Business Mailing Address Fax Number:
320-743-4119

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11959 77TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEAR LAKE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55319-9420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-743-3639
Provider Business Practice Location Address Fax Number:
320-743-4119
Provider Enumeration Date:
07/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  04341 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3577252 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05Q34CA . This is a "BC/BS INDIVIDUAL" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP 25252 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 05Q33CA . This is a "BC/BS BUSINESS #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1016732 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 110586 . This is a "U-CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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