Provider Demographics
NPI:1790078954
Name:CASEY, ANNETTE MARIE (MA/CCC-SLP/L)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:MARIE
Last Name:CASEY
Suffix:
Gender:F
Credentials:MA/CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5970 295TH ST
Mailing Address - Street 2:
Mailing Address - City:STACY
Mailing Address - State:MN
Mailing Address - Zip Code:55079-8614
Mailing Address - Country:US
Mailing Address - Phone:612-716-0743
Mailing Address - Fax:651-408-9037
Practice Address - Street 1:750 E LOUISIANA ST
Practice Address - Street 2:
Practice Address - City:SAINT CROIX FALLS
Practice Address - State:WI
Practice Address - Zip Code:54024-9501
Practice Address - Country:US
Practice Address - Phone:715-483-9815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3472-154235Z00000X
MN5580235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist