Provider Demographics
NPI:1457606212
Name:BLACKBURN, CASEY JANE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:JANE
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:JANE
Other - Last Name:MAHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:402 ROGERS PARKWAY
Mailing Address - Street 2:THE KESSLER CENTER
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617
Mailing Address - Country:US
Mailing Address - Phone:585-957-7179
Mailing Address - Fax:585-924-7049
Practice Address - Street 1:402 ROGERS PARKWAY
Practice Address - Street 2:THE KESSLER CENTER
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617
Practice Address - Country:US
Practice Address - Phone:585-957-7179
Practice Address - Fax:585-924-7049
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010723235Z00000X
NY021891235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist