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Individual

ROGER JOHN CASEY JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
ATC

Contact information

Practice address
12280 228TH ST N, SCANDIA, MN 55073-9467
(651) 399-8497
Mailing address
12280 228TH ST N, SCANDIA, MN 55073-9467
(651) 399-8497

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
304448
MN
2255A2300X
Athletic Trainer
1109
MN

Other

Enumeration date
02/12/2013
Last updated
05/18/2016
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