Provider Demographics
NPI:1841960796
Name:CARROLL, CASSIDY L
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:L
Last Name:CARROLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 SAW MILL RD
Mailing Address - Street 2:BUILDING 4 APT 4330
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5131
Mailing Address - Country:US
Mailing Address - Phone:845-519-7590
Mailing Address - Fax:
Practice Address - Street 1:50 SAW MILL RD
Practice Address - Street 2:BUILDING 4 APT 4330
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5131
Practice Address - Country:US
Practice Address - Phone:845-519-7590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist