Provider Demographics
NPI:1619190220
Name:BISHMAN, KASEY J (LICSW)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:J
Last Name:BISHMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 PHEASANT RUN DR NE
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-3208
Mailing Address - Country:US
Mailing Address - Phone:507-676-5932
Mailing Address - Fax:
Practice Address - Street 1:1414 S OAK AVE
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-3900
Practice Address - Country:US
Practice Address - Phone:507-676-6834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN142001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN287153000Medicaid
MN287153000Medicaid
MN800001857Medicare PIN