Provider Demographics
NPI:1215189881
Name:CASSERLY, CAROL F (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:F
Last Name:CASSERLY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-6859
Mailing Address - Country:US
Mailing Address - Phone:973-948-5701
Mailing Address - Fax:
Practice Address - Street 1:318 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-6859
Practice Address - Country:US
Practice Address - Phone:973-948-5701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00138400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist