Provider Demographics
NPI:1801333745
Name:HERCHENROEDER, KASEY (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:HERCHENROEDER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14926 COPPER TREE WAY
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-8972
Mailing Address - Country:US
Mailing Address - Phone:765-438-8994
Mailing Address - Fax:
Practice Address - Street 1:14926 COPPER TREE WAY
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-8972
Practice Address - Country:US
Practice Address - Phone:765-438-8994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22005315A235Z00000X
NC12254235Z00000X
FLSA15025235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist