Provider Demographics
NPI:1992957781
Name:ROWE, CASEY M (WCMT, NCTMB)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:M
Last Name:ROWE
Suffix:
Gender:F
Credentials:WCMT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 OLD INDIAN TRL
Mailing Address - Street 2:
Mailing Address - City:DE FOREST
Mailing Address - State:WI
Mailing Address - Zip Code:53532-3078
Mailing Address - Country:US
Mailing Address - Phone:608-692-8366
Mailing Address - Fax:
Practice Address - Street 1:507 OLD INDIAN TRL
Practice Address - Street 2:
Practice Address - City:DE FOREST
Practice Address - State:WI
Practice Address - Zip Code:53532-3078
Practice Address - Country:US
Practice Address - Phone:608-692-8366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2375-046171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor