Provider Demographics
NPI:1538471685
Name:CASSADA, JESSIE L (AUD, F-AAA)
Entity Type:Individual
Prefix:DR
First Name:JESSIE
Middle Name:L
Last Name:CASSADA
Suffix:
Gender:F
Credentials:AUD, F-AAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 BIRCH ST
Mailing Address - Street 2:STE 304
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-2752
Mailing Address - Country:US
Mailing Address - Phone:603-880-0090
Mailing Address - Fax:
Practice Address - Street 1:44 BIRCH ST STE 304A
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-2752
Practice Address - Country:US
Practice Address - Phone:603-432-8104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA998231H00000X
VT8052577231H00000X
NHA587231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110094374AMedicaid
VT1022109Medicaid