Provider Demographics
NPI:1003597907
Name:DEPAUW, CASEY NICHOLE (SLP)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:NICHOLE
Last Name:DEPAUW
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:NICHOLE
Other - Last Name:LEMERAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1123 BRIARWOOD CT
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-2069
Mailing Address - Country:US
Mailing Address - Phone:517-212-5814
Mailing Address - Fax:
Practice Address - Street 1:1123 BRIARWOOD CT
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-2069
Practice Address - Country:US
Practice Address - Phone:517-212-5814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6263154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist