Provider Demographics
NPI:1164044145
Name:EVERETT, CASSIDY LYNN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CASSIDY
Middle Name:LYNN
Last Name:EVERETT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:CASSIDY
Other - Middle Name:LYNN
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:2102 N CHAMBERS TER
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-6234
Mailing Address - Country:US
Mailing Address - Phone:918-208-6894
Mailing Address - Fax:
Practice Address - Street 1:2102 N CHAMBERS TER
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-6234
Practice Address - Country:US
Practice Address - Phone:918-208-6894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
OK5688235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200954770AMedicaid