MEDICARE: MS. CASEY MULLIGAN WALSH MS, 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	009837-1	NY

General Provider Information

NPI Number	:	1396989448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CASEY MULLIGAN WALSH MS, CCC-SLP

Provider Business Mailing Address
First Line	:	68 VALLEY DR
Second Line	:
City	:	WEST SAND LAKE
State	:	NY
Zip	:	12196-1739
Country	:	US
Telephone Number	:	518-674-4114
Fax Number	:	518-279-0612

Provider Business Practice Location Address
First Line	:	68 VALLEY DR
Second Line	:
City	:	WEST SAND LAKE
State	:	NY
Zip	:	12196-1739
Country	:	US
Telephone Number	:	518-674-4114
Fax Number	:	518-279-0612

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

Provider Enumeration Date	:	04/20/2009
Last Update Date	:	04/20/2009

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