Provider Demographics
NPI:1477075901
Name:BEAN, CASEY (AUDIOLOGY ASSISTANT)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:BEAN
Suffix:
Gender:F
Credentials:AUDIOLOGY ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4626 26TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-1701
Mailing Address - Country:US
Mailing Address - Phone:941-755-5535
Mailing Address - Fax:
Practice Address - Street 1:4626 26TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-1701
Practice Address - Country:US
Practice Address - Phone:941-755-5535
Practice Address - Fax:941-756-1000
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS4915237700000X
FLAI1622355A2700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355A2700XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistAudiology Assistant
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist