Provider Demographics
NPI:1912434531
Name:CASEY, KELLY (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:CASEY
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 1:255 S CHEROKEE ST
Mailing Address - Street 2:APT. 2326
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80223-1863
Mailing Address - Country:US
Mailing Address - Phone:914-656-9704
Mailing Address - Fax:
Practice Address - Street 1:21 N 1ST AVE STE 190
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-1641
Practice Address - Country:US
Practice Address - Phone:720-506-5267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0002562235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist