Provider Demographics
NPI:1588170658
Name:CASKEY-SHIVELY, PRISCILLA LYNN (SLP)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:LYNN
Last Name:CASKEY-SHIVELY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 DUNDEE RD STE 704
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2442
Mailing Address - Country:US
Mailing Address - Phone:847-498-5437
Mailing Address - Fax:312-893-2118
Practice Address - Street 1:3100 DUNDEE RD STE 704
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2442
Practice Address - Country:US
Practice Address - Phone:847-498-5437
Practice Address - Fax:312-893-2118
Is Sole Proprietor?:No
Enumeration Date:2017-12-27
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146013694235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist