Provider Demographics
NPI:1255741047
Name:BAUER, CASEY
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:BAUER
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 1:117B N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-3928
Mailing Address - Country:US
Mailing Address - Phone:601-889-9800
Mailing Address - Fax:601-889-9885
Practice Address - Street 1:117B N MAIN ST
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-3928
Practice Address - Country:US
Practice Address - Phone:601-889-9800
Practice Address - Fax:601-889-9885
Is Sole Proprietor?:No
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist