Provider Demographics
NPI:1568734598
Name:CASSITY, JESSICA (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CASSITY
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 1:110 OWINGS GATE RD
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3541
Mailing Address - Country:US
Mailing Address - Phone:410-871-2990
Mailing Address - Fax:410-871-2990
Practice Address - Street 1:505 OLD WESTMINSTER PIKE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6279
Practice Address - Country:US
Practice Address - Phone:410-871-2990
Practice Address - Fax:410-871-2990
Is Sole Proprietor?:No
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05836235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD05836OtherSTATE LICENSE