Provider Demographics
NPI:1003292277
Name:BRICKEY, KASEY (AUD)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:BRICKEY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:KASEY
Other - Middle Name:AMANDA
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2521 BOONE RD SE STE 120
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-9391
Mailing Address - Country:US
Mailing Address - Phone:971-701-6322
Mailing Address - Fax:971-915-2689
Practice Address - Street 1:2521 BOONE RD SE STE 120
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-9391
Practice Address - Country:US
Practice Address - Phone:971-701-6322
Practice Address - Fax:971-915-2689
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT332S00000X
231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTPENDINGMedicaid