Provider Demographics
NPI:1851451157
Name:KOHL, CASEY (LCSW)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:KOHL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 SE CASS AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-4953
Mailing Address - Country:US
Mailing Address - Phone:541-671-2040
Mailing Address - Fax:775-623-6584
Practice Address - Street 1:753 SE MAIN ST # 210
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-3984
Practice Address - Country:US
Practice Address - Phone:541-671-2040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR37191041C0700X
NV4957-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical