Provider Demographics
NPI:1871045542
Name:PELLETIER, CASSANDRA L (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:L
Last Name:PELLETIER
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 1:56 STARLING DR
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-2779
Mailing Address - Country:US
Mailing Address - Phone:207-316-5180
Mailing Address - Fax:
Practice Address - Street 1:797 WILSON ST STE 2
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1003
Practice Address - Country:US
Practice Address - Phone:207-947-8493
Practice Address - Fax:207-990-4819
Is Sole Proprietor?:No
Enumeration Date:2016-10-28
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP2470235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist