Provider Demographics
NPI:1033705959
Name:CASEY, JEFFREY (HIS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:CASEY
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5311 BRYANT ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-2403
Mailing Address - Country:US
Mailing Address - Phone:814-528-4700
Mailing Address - Fax:
Practice Address - Street 1:4402 PEACH ST STE 2A
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-1373
Practice Address - Country:US
Practice Address - Phone:814-868-4890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF03641237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist