Provider Demographics
NPI:1437466505
Name:CASEY, CAROLE ANN
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:ANN
Last Name:CASEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 CARRIAGE DR APT 2
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1821
Mailing Address - Country:US
Mailing Address - Phone:716-698-1561
Mailing Address - Fax:
Practice Address - Street 1:75 CARRIAGE DR APT 2
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1821
Practice Address - Country:US
Practice Address - Phone:716-698-1561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009657-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist