Provider Demographics
NPI:1740558063
Name:CASEY, FAITH JOAN
Entity Type:Individual
Prefix:MISS
First Name:FAITH
Middle Name:JOAN
Last Name:CASEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 PLANK ROAD
Mailing Address - Street 2:PLANK ROAD SOUTH ELEMENTARY SCHOOL
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580
Mailing Address - Country:US
Mailing Address - Phone:585-671-3190
Mailing Address - Fax:
Practice Address - Street 1:715 PLANK ROAD
Practice Address - Street 2:PLANK ROAD SOUTH ELEMENTARY SCHOOL
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580
Practice Address - Country:US
Practice Address - Phone:585-671-3190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004538235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist