Provider Demographics
NPI:1952179087
Name:SMITH, CASSIDY RAE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:RAE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WASHINGTON DR APT 723
Mailing Address - Street 2:
Mailing Address - City:EAST PENNSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:17025-2497
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7 WASHINGTON DR APT 723
Practice Address - Street 2:
Practice Address - City:EAST PENNSBORO
Practice Address - State:PA
Practice Address - Zip Code:17025-2497
Practice Address - Country:US
Practice Address - Phone:724-809-9619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL015984235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist