Provider Demographics
NPI:1629490404
Name:CASEY, KERRI (LAC)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:CASEY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 RIVER ST STE 140
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156-2242
Mailing Address - Country:US
Mailing Address - Phone:802-886-1153
Mailing Address - Fax:
Practice Address - Street 1:368 RIVER ST STE 140
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VT
Practice Address - Zip Code:05156-2242
Practice Address - Country:US
Practice Address - Phone:802-886-1153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-13
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1388171100000X
VT091.0134029171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturist