Provider Demographics
NPI:1417234592
Name:CASE, JACEY CAROL (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JACEY
Middle Name:CAROL
Last Name:CASE
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 1:1105 DEER ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-5413
Mailing Address - Country:US
Mailing Address - Phone:501-327-5883
Mailing Address - Fax:501-327-5620
Practice Address - Street 1:1105 DEER ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-5413
Practice Address - Country:US
Practice Address - Phone:501-327-5883
Practice Address - Fax:501-327-5620
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#2759235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist