Provider Demographics
NPI:1730668674
Name:WILSON, CASSIE LYNN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:LYNN
Last Name:WILSON
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 1:454 KERR RD
Mailing Address - Street 2:
Mailing Address - City:ODENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35120-7440
Mailing Address - Country:US
Mailing Address - Phone:662-321-1608
Mailing Address - Fax:
Practice Address - Street 1:7054 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35125-5117
Practice Address - Country:US
Practice Address - Phone:205-227-7985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-11
Last Update Date:2018-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4353235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist