Organization
CASEY'S SPECIALTY SPEECH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CASEY ULRICH M.S., CCC-SLP (OWNER/SPEECH THERAPIST)
(208) 242-7377
Entity
Organization
Contact information
Practice address
611 WILSON AVE STE 6C, POCATELLO, ID 83201-5046
(208) 242-7377
(208) 417-0956
Mailing address
13413 N MOONGLOW LN, POCATELLO, ID 83202-5122
(208) 242-7377
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1528624673
—
ID
Enumeration date
05/14/2019
Last updated
05/17/2022
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