Provider Demographics
NPI:1730847997
Name:KASPER, KACIE
Entity type:Individual
Prefix:
First Name:KACIE
Middle Name:
Last Name:KASPER
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 1:1704 NORTH RD SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2958
Mailing Address - Country:US
Mailing Address - Phone:330-856-4111
Mailing Address - Fax:330-856-5839
Practice Address - Street 1:1704 NORTH RD SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2958
Practice Address - Country:US
Practice Address - Phone:330-856-4111
Practice Address - Fax:330-856-5839
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA32064134OtherDRIVER LICENSE