Provider Demographics
NPI:1710120001
Name:LYNEMA, CASEY CHERIE (MED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:CHERIE
Last Name:LYNEMA
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 AUTUMN RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-4746
Mailing Address - Country:US
Mailing Address - Phone:912-269-1516
Mailing Address - Fax:
Practice Address - Street 1:110 AUTUMN RIDGE CT
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-4746
Practice Address - Country:US
Practice Address - Phone:912-269-1516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006981235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist