Provider Demographics
NPI:1477251783
Name:HIRST, KASEY
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:HIRST
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 1:2271 S ELEMENT WAY APT 107
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-4081
Mailing Address - Country:US
Mailing Address - Phone:608-395-7118
Mailing Address - Fax:
Practice Address - Street 1:2271 S ELEMENT WAY APT 107
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-4081
Practice Address - Country:US
Practice Address - Phone:608-395-7118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99114328A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker