Provider Demographics
NPI:1861931362
Name:CASPERSON, JOY
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:CASPERSON
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 1:3675 MACEDONIA CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:METROPOLIS
Mailing Address - State:IL
Mailing Address - Zip Code:62960-4211
Mailing Address - Country:US
Mailing Address - Phone:270-908-0461
Mailing Address - Fax:270-366-0780
Practice Address - Street 1:6201 BENTON RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-1304
Practice Address - Country:US
Practice Address - Phone:270-908-0461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician