Individual
CASEY KOENEKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., CCC-SLP, TSSLD
Contact information
Practice address
11502 OCEAN PROMENADE, BELLE HARBOR, NY 11694-2412
(718) 634-3400
Mailing address
11502 OCEAN PROMENADE, BELLE HARBOR, NY 11694-2412
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/07/2020
Last updated
11/19/2021
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