Provider Demographics
NPI:1205224524
Name:MAYES, CASEY LYNN (MS/CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:CASEY
Middle Name:LYNN
Last Name:MAYES
Suffix:
Gender:F
Credentials:MS/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 DOLARON LN
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-8111
Mailing Address - Country:US
Mailing Address - Phone:304-421-5764
Mailing Address - Fax:
Practice Address - Street 1:501 CALDWELL LN
Practice Address - Street 2:
Practice Address - City:DUNBAR
Practice Address - State:WV
Practice Address - Zip Code:25064-2026
Practice Address - Country:US
Practice Address - Phone:304-744-4761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV-1381235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist