Provider Demographics
NPI:1134615446
Name:CASKEY, SAMANTHA HALEY BURTON
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:HALEY BURTON
Last Name:CASKEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:HAYLEY
Other - Last Name:BURTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1003 7TH AVE
Mailing Address - Street 2:STE A
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033
Mailing Address - Country:US
Mailing Address - Phone:425-658-3016
Mailing Address - Fax:425-658-3017
Practice Address - Street 1:1003 7TH AVE
Practice Address - Street 2:STE A
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033
Practice Address - Country:US
Practice Address - Phone:425-658-3016
Practice Address - Fax:425-658-3017
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
WACB60893736106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2111488Medicaid