Provider Demographics
NPI:1811991771
Name:KASEWURM, GYL A (AUD, FAAA)
Entity type:Individual
Prefix:MRS
First Name:GYL
Middle Name:A
Last Name:KASEWURM
Suffix:
Gender:F
Credentials:AUD, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 RENAISSANCE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-2180
Mailing Address - Country:US
Mailing Address - Phone:269-982-3444
Mailing Address - Fax:269-982-3445
Practice Address - Street 1:511 RENAISSANCE DR
Practice Address - Street 2:STE 100
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2180
Practice Address - Country:US
Practice Address - Phone:269-982-3444
Practice Address - Fax:269-982-3445
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000002231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI901870694Medicaid
MI804989111Medicaid