Provider Demographics
NPI:1174108492
Name:HAGER, KASEY NICHOLE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:NICHOLE
Last Name:HAGER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:KASEY
Other - Middle Name:N
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSCCC-SLP
Mailing Address - Street 1:1201 US HIGHWAY 1 STE 210
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-3547
Mailing Address - Country:US
Mailing Address - Phone:561-776-8612
Mailing Address - Fax:
Practice Address - Street 1:1201 US HIGHWAY 1 STE 210
Practice Address - Street 2:
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-3547
Practice Address - Country:US
Practice Address - Phone:561-776-8612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17350235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist