Provider Demographics
NPI:1780404129
Name:GURLITZ, CASEY M (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:M
Last Name:GURLITZ
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SAYBROOK WAY
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-3173
Mailing Address - Country:US
Mailing Address - Phone:774-437-9012
Mailing Address - Fax:
Practice Address - Street 1:543 PROSPECT STREET
Practice Address - Street 2:
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583
Practice Address - Country:US
Practice Address - Phone:508-459-2781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78717-SP-SL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist