Provider Demographics
NPI:1598065856
Name:CASSIDY, JANET (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 WINNE RD
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-4231
Mailing Address - Country:US
Mailing Address - Phone:518-439-0688
Mailing Address - Fax:
Practice Address - Street 1:25 UNION AVE
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-1610
Practice Address - Country:US
Practice Address - Phone:518-439-7681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002706235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist