Provider Demographics
NPI:1992279228
Name:CASKEY, SHALISA MARIE
Entity type:Individual
Prefix:
First Name:SHALISA
Middle Name:MARIE
Last Name:CASKEY
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 1:307 DONATION ST
Mailing Address - Street 2:
Mailing Address - City:KELSO
Mailing Address - State:WA
Mailing Address - Zip Code:98626-4216
Mailing Address - Country:US
Mailing Address - Phone:360-270-3956
Mailing Address - Fax:
Practice Address - Street 1:307 DONATION ST
Practice Address - Street 2:
Practice Address - City:KELSO
Practice Address - State:WA
Practice Address - Zip Code:98626-4216
Practice Address - Country:US
Practice Address - Phone:360-270-3956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-21
Last Update Date:2022-03-26
Deactivation Date:2022-02-13
Deactivation Code:
Reactivation Date:2022-03-24
Provider Licenses
StateLicense IDTaxonomies
106S00000X
WA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician