MEDICARE: CASEY WISNIEWSKI MA CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	41YS01271100	NJ

General Provider Information

NPI Number	:	1306795315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY WISNIEWSKI MA CCC-SLP

Provider Business Mailing Address
First Line	:	1 E 1ST ST
Second Line	:
City	:	BAYONNE
State	:	NJ
Zip	:	07002-3401
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 E 1ST ST
Second Line	:
City	:	BAYONNE
State	:	NJ
Zip	:	07002-3401
Country	:	US
Telephone Number	:	551-221-7956
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2026
Last Update Date	:	01/23/2026

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Directions to “ CASEY WISNIEWSKI MA CCC-SLP” Practice Location

Language	Start Address	Practice Location

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