Provider Demographics
NPI:1770982613
Name:MASALEHDANI, CASEY (MA, CCC-SLP, TSSLD)
Entity type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:
Last Name:MASALEHDANI
Suffix:
Gender:F
Credentials:MA, CCC-SLP, TSSLD
Other - Prefix:MS
Other - First Name:CASEY
Other - Middle Name:
Other - Last Name:KAHNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP, TSSLD
Mailing Address - Street 1:6 GEORGE CT
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-1314
Mailing Address - Country:US
Mailing Address - Phone:631-379-6693
Mailing Address - Fax:
Practice Address - Street 1:6 GEORGE CT
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-1314
Practice Address - Country:US
Practice Address - Phone:631-379-6693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-15
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025071-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist