Provider Demographics
NPI:1649582420
Name:BLACKBURN, CASEY JEAN (MSCFSLP)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:JEAN
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:MSCFSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 CRYSTAL SPRING LN
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-4196
Mailing Address - Country:US
Mailing Address - Phone:812-453-9353
Mailing Address - Fax:
Practice Address - Street 1:1811 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4604
Practice Address - Country:US
Practice Address - Phone:931-801-5131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3680235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist