Provider Demographics
NPI:1528267788
Name:CASEY, MICHELE LYNN (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:LYNN
Last Name:CASEY
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MISS
Other - First Name:MICHELE
Other - Middle Name:LYNN
Other - Last Name:MCNICHOLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:263 RIVER AVE
Mailing Address - Street 2:UNIT 62
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3318
Mailing Address - Country:US
Mailing Address - Phone:201-888-5235
Mailing Address - Fax:
Practice Address - Street 1:263 RIVER AVE
Practice Address - Street 2:UNIT 62
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3318
Practice Address - Country:US
Practice Address - Phone:201-888-5235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012640-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist