Provider Demographics
NPI:1730164138
Name:CASEY, BROOKE C E (AUD)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:C E
Last Name:CASEY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:C
Other - Last Name:CASEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD
Mailing Address - Street 1:211 E SOUTHLAKE BLVD STE 114
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6274
Mailing Address - Country:US
Mailing Address - Phone:817-585-4080
Mailing Address - Fax:
Practice Address - Street 1:211 E SOUTHLAKE BLVD STE 114
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6274
Practice Address - Country:US
Practice Address - Phone:817-585-4080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51545231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ15560Medicare UPIN
8B7860Medicare PIN