Provider Demographics
NPI:1487534749
Name:FANSHER, CASIE M
Entity type:Individual
Prefix:
First Name:CASIE
Middle Name:M
Last Name:FANSHER
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 1:25900 CAMP GROUND RD
Mailing Address - Street 2:
Mailing Address - City:DE KALB
Mailing Address - State:MO
Mailing Address - Zip Code:64440-8912
Mailing Address - Country:US
Mailing Address - Phone:217-779-1180
Mailing Address - Fax:800-687-5070
Practice Address - Street 1:10502 N AMBASSADOR DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64153-1278
Practice Address - Country:US
Practice Address - Phone:816-608-1951
Practice Address - Fax:800-687-5070
Is Sole Proprietor?:No
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025032049103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst