Provider Demographics
NPI:1013629203
Name:MCCLAIN, CASSIE CUMMINGS (HIS)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:CUMMINGS
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 N LOCUST AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-2277
Mailing Address - Country:US
Mailing Address - Phone:931-762-3710
Mailing Address - Fax:
Practice Address - Street 1:1407 N LOCUST AVE STE 102
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-2277
Practice Address - Country:US
Practice Address - Phone:931-762-3710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1030237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist