Provider Demographics
NPI:1861385205
Name:HAGERSTROM, CASEY (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:HAGERSTROM
Suffix:
Gender:F
Credentials:MS, CF-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 EXECUTIVE DR STE LL105
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1718
Mailing Address - Country:US
Mailing Address - Phone:516-248-7572
Mailing Address - Fax:
Practice Address - Street 1:348 N WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-1747
Practice Address - Country:US
Practice Address - Phone:516-492-4562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist