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General NPI Number Information
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NPI Number | 1528624673
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Entity Type | Organization
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Legal Business Name | CASEY'S SPECIALTY SPEECH, LLC
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Dates
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Enumeration Date | 05/14/2019
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Last Update Date | 05/17/2022
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Provider Practice Location Address
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Address Line | 611 WILSON AVE STE 6C
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City | POCATELLO
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State | ID
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Zip | 83201-5046
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Country | US
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Telephone | 208-242-7377
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Fax | 208-417-0956
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Provider Business Mailing Address
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Address Line | 13413 N MOONGLOW LN
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City | POCATELLO
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State | ID
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Zip | 83202-5122
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Country | US
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Telephone | 208-242-7377
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Fax |
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Authorized Official
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Title or Position | OWNER/SPEECH THERAPIST
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Name | CASEY ULRICH
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Credential | M.S., CCC-SLP
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Telephone | 208-242-7377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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