Provider Demographics
NPI:1841507803
Name:KLEY, CASEY (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:KLEY
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 N RECKER RD
Mailing Address - Street 2:UNIT 112
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-4425
Mailing Address - Country:US
Mailing Address - Phone:248-766-4957
Mailing Address - Fax:
Practice Address - Street 1:1340 N RECKER RD
Practice Address - Street 2:UNIT 112
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-4425
Practice Address - Country:US
Practice Address - Phone:248-766-4957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP6958235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist