Provider Demographics
NPI:1639322399
Name:HIGGINS-POOPOR, CASEYANNE (SLP-CCC)
Entity Type:Individual
Prefix:MS
First Name:CASEYANNE
Middle Name:
Last Name:HIGGINS-POOPOR
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:CASEYANNE
Other - Middle Name:
Other - Last Name:HIGGINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP-CCC
Mailing Address - Street 1:2 ITHACA RD
Mailing Address - Street 2:
Mailing Address - City:NEW FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06812
Mailing Address - Country:US
Mailing Address - Phone:203-768-5142
Mailing Address - Fax:
Practice Address - Street 1:2 ITHACA RD
Practice Address - Street 2:
Practice Address - City:NEW FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06812
Practice Address - Country:US
Practice Address - Phone:203-768-5142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018379235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist