Provider Demographics
NPI:1558726976
Name:KEY, CASEY R (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:R
Last Name:KEY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:
Other - Last Name:WILKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1114
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:FL
Mailing Address - Zip Code:32147-1114
Mailing Address - Country:US
Mailing Address - Phone:386-937-3118
Mailing Address - Fax:
Practice Address - Street 1:615 HUNTER RD
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177
Practice Address - Country:US
Practice Address - Phone:386-937-3118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-30
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA14690235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist