Provider Demographics
NPI:1477232718
Name:CASIDAY, ALISHA MARIE
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:MARIE
Last Name:CASIDAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1764 GATEWAY BLVD APT 543
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-9121
Mailing Address - Country:US
Mailing Address - Phone:608-346-3375
Mailing Address - Fax:
Practice Address - Street 1:1326 CRESTON PARK DR
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-1156
Practice Address - Country:US
Practice Address - Phone:608-501-2016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI134439121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker