Provider Demographics
NPI:1780372284
Name:WRIGHT, CASEY D (PHD)
Entity type:Individual
Prefix:DR
First Name:CASEY
Middle Name:D
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11649 N PORT WASHINGTON RD STE 201
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3459
Mailing Address - Country:US
Mailing Address - Phone:262-789-1191
Mailing Address - Fax:262-478-0030
Practice Address - Street 1:11649 N PORT WASHINGTON RD STE 201
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3459
Practice Address - Country:US
Practice Address - Phone:262-789-1191
Practice Address - Fax:262-478-0030
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5037-57103TB0200X, 103TC0700X, 103TH0004X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth