Provider Demographics
NPI:1407048838
Name:PERRY, CASEY DANIELLE (AUD)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:DANIELLE
Last Name:PERRY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 ROYCE AVE
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-0539
Mailing Address - Country:US
Mailing Address - Phone:940-595-8888
Mailing Address - Fax:
Practice Address - Street 1:2100 N RAGUET
Practice Address - Street 2:STE 203F
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75904
Practice Address - Country:US
Practice Address - Phone:936-468-1252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80104231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist