Provider Demographics
NPI:1962012492
Name:GAUL, CASEY I (AUD,CCC-A,FAAA)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:
Last Name:GAUL
Suffix:I
Gender:F
Credentials:AUD,CCC-A,FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 3RD AVE STE C
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5809
Mailing Address - Country:US
Mailing Address - Phone:570-714-3434
Mailing Address - Fax:570-714-6355
Practice Address - Street 1:423 3RD AVE STE C
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5809
Practice Address - Country:US
Practice Address - Phone:570-714-3434
Practice Address - Fax:570-714-6355
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006704237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1881624856Medicaid