Provider Demographics
NPI:1629059688
Name:CASEY, MARY E (MA LP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:CASEY
Suffix:
Gender:F
Credentials:MA LP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CASEY
Other - Last Name:HVISTENDAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA LP
Mailing Address - Street 1:301 SOUTH DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057
Mailing Address - Country:US
Mailing Address - Phone:507-650-4127
Mailing Address - Fax:507-650-9261
Practice Address - Street 1:301 SOUTH DIVISION ST
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057
Practice Address - Country:US
Practice Address - Phone:507-650-4127
Practice Address - Fax:507-650-9261
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3563103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN60G07CAOtherBLUE CROSS BLUE SHIELD
MN6252382OtherMEDICA
MN6252382OtherUNITED HEALTH CARE