Provider Demographics
NPI:1356097562
Name:CARLSON, CASSIDY (MS CF-SLP)
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 SE 7TH AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-4848
Mailing Address - Country:US
Mailing Address - Phone:352-795-4114
Mailing Address - Fax:352-563-2438
Practice Address - Street 1:255 SE 7TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-4848
Practice Address - Country:US
Practice Address - Phone:352-795-4114
Practice Address - Fax:352-563-2438
Is Sole Proprietor?:No
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ10480235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist