Provider Demographics
NPI:1619759420
Name:EXACUSTIDES, KASEY (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KASEY
Middle Name:
Last Name:EXACUSTIDES
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 1:202 BLUESTONE DR
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-1085
Mailing Address - Country:US
Mailing Address - Phone:412-926-4738
Mailing Address - Fax:
Practice Address - Street 1:1500 ARDMORE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15221-4468
Practice Address - Country:US
Practice Address - Phone:412-271-8347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL015891235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist