Provider Demographics
NPI:1790466597
Name:FRIEDMAN, CASSIDY JORDYN (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:JORDYN
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 PENNY LN
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-3737
Mailing Address - Country:US
Mailing Address - Phone:847-436-7133
Mailing Address - Fax:
Practice Address - Street 1:484 PENNY LN
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-3737
Practice Address - Country:US
Practice Address - Phone:847-436-7133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146017192235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist