Provider Demographics
NPI:1962229211
Name:BLAIR-SMITH, CASIE RUTH (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CASIE
Middle Name:RUTH
Last Name:BLAIR-SMITH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:CASIE
Other - Middle Name:RUTH
Other - Last Name:BLAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8950 CARRIAGE LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-2212
Mailing Address - Country:US
Mailing Address - Phone:317-612-1254
Mailing Address - Fax:
Practice Address - Street 1:1410 WADE ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46203-4340
Practice Address - Country:US
Practice Address - Phone:317-226-4234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22008025A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist