Provider Demographics
NPI:1669035101
Name:DOHSE, CASEY R (MFT)
Entity Type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:R
Last Name:DOHSE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MRS
Other - First Name:CASEY-ANN
Other - Middle Name:R
Other - Last Name:PETTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4513 VERNON BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-4964
Mailing Address - Country:US
Mailing Address - Phone:608-236-4460
Mailing Address - Fax:608-236-4461
Practice Address - Street 1:4513 VERNON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-4964
Practice Address - Country:US
Practice Address - Phone:608-236-4460
Practice Address - Fax:608-236-4461
Is Sole Proprietor?:No
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI502-228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist