Provider Demographics
NPI:1720407877
Name:CASADY, CAITLIN
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:CASADY
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:PO BOX 2099
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82931-2099
Mailing Address - Country:US
Mailing Address - Phone:307-789-3113
Mailing Address - Fax:307-789-8120
Practice Address - Street 1:22 ANTELOPE DR
Practice Address - Street 2:
Practice Address - City:BEAR RIVER
Practice Address - State:WY
Practice Address - Zip Code:82930-9551
Practice Address - Country:US
Practice Address - Phone:307-789-3113
Practice Address - Fax:307-789-8120
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator