Provider Demographics
NPI:1508409947
Name:HEATHCOTE, CASSIDEY DANIELLE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CASSIDEY
Middle Name:DANIELLE
Last Name:HEATHCOTE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SE STEPHENS ST
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-4818
Mailing Address - Country:US
Mailing Address - Phone:541-900-1418
Mailing Address - Fax:541-900-1419
Practice Address - Street 1:1000 SE STEPHENS ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-4818
Practice Address - Country:US
Practice Address - Phone:541-900-1418
Practice Address - Fax:541-900-1419
Is Sole Proprietor?:No
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR016445235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist