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Individual

MRS. CASEY L SEPICH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
AUD

Contact information

Practice address
1701 E COLLEGE AVE, BLOOMINGTON, IL 61704-2101
(309) 664-3000
Mailing address
1701 E COLLEGE AVE, BLOOMINGTON, IL 61704-2101
(309) 664-3000

Taxonomy

Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
147001336
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
IL2613
MEDICARE GROUP PTAN
IL
01
IL2613046
MEDICARE INDIVIDUAL PTAN
IL
Enumeration date
02/02/2010
Last updated
06/11/2010
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