Provider Demographics
NPI:1669873964
Name:SHEPPARD, CASSIE ANNE (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CASSIE
Middle Name:ANNE
Last Name:SHEPPARD
Suffix:
Gender:
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4625 N BROADWAY
Mailing Address - Street 2:STE 5
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-5501
Mailing Address - Country:US
Mailing Address - Phone:701-839-5656
Mailing Address - Fax:701-839-9522
Practice Address - Street 1:4625 N BROADWAY
Practice Address - Street 2:STE 5
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-5501
Practice Address - Country:US
Practice Address - Phone:701-839-5656
Practice Address - Fax:701-839-9522
Is Sole Proprietor?:No
Enumeration Date:2014-09-06
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1375235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1375OtherND STATE SLP LICENSE
ND1375OtherND SLP LICENSE
ND1461483Medicaid