Provider Demographics
NPI:1720301948
Name:SURBER, CASEY LAUREL (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:CASEY
Middle Name:LAUREL
Last Name:SURBER
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:THE UNIVERSITY OF TENNESSEE
Mailing Address - Street 2:578 SOUTH STADIUM HALL
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37996-0001
Mailing Address - Country:US
Mailing Address - Phone:865-974-5019
Mailing Address - Fax:865-974-1539
Practice Address - Street 1:THE UNIVERSITY OF TENNESSEE
Practice Address - Street 2:578 SOUTH STADIUM HALL
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37996-0001
Practice Address - Country:US
Practice Address - Phone:865-974-5019
Practice Address - Fax:865-974-1539
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3979235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist