Provider Demographics
NPI:1104191998
Name:MELLARS, CASIE LYNN (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:CASIE
Middle Name:LYNN
Last Name:MELLARS
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 1:204 W HYDE PARK PL
Mailing Address - Street 2:APT 207
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2343
Mailing Address - Country:US
Mailing Address - Phone:765-603-9273
Mailing Address - Fax:
Practice Address - Street 1:13810 SHELDON RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-3679
Practice Address - Country:US
Practice Address - Phone:813-333-9996
Practice Address - Fax:813-616-8507
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA12891235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist