Provider Demographics
NPI:1679959381
Name:DANGERFIELD, CASSIDEE ANN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CASSIDEE
Middle Name:ANN
Last Name:DANGERFIELD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:CASSIDEE
Other - Middle Name:ANN
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:3600 LIND AVE SW
Mailing Address - Street 2:SUITE 100 - ATTN CREDENTIALING
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057
Mailing Address - Country:US
Mailing Address - Phone:425-228-3440
Mailing Address - Fax:
Practice Address - Street 1:3600 LIND AVE SW STE 160
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-4934
Practice Address - Country:US
Practice Address - Phone:256-564-2154
Practice Address - Fax:425-656-5075
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASI60590508235Z00000X
WALL60700286235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist