Provider Demographics
NPI:1164239653
Name:CASEY, AMANDA (IBCLC)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:CASEY
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 NE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-1303
Mailing Address - Country:US
Mailing Address - Phone:816-838-2032
Mailing Address - Fax:
Practice Address - Street 1:672 SE BAYBERRY LN STE 101
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-4262
Practice Address - Country:US
Practice Address - Phone:816-281-7558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOL-315015174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN