Provider Demographics
NPI:1548363328
Name:CASE, SUE ANNE (SLP)
Entity type:Individual
Prefix:MRS
First Name:SUE
Middle Name:ANNE
Last Name:CASE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 GARRETT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41004-8200
Mailing Address - Country:US
Mailing Address - Phone:606-735-3654
Mailing Address - Fax:606-735-2527
Practice Address - Street 1:242 GARRETT AVE
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41004-8200
Practice Address - Country:US
Practice Address - Phone:606-735-3654
Practice Address - Fax:606-735-2527
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0578235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00091OtherCBIS FOR FIRST STEPS PROG