Provider Demographics
NPI:1043064587
Name:CASSIDY, KATELYN (SLP-CCC)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:
Other - Last Name:ZIEGLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1001
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-1001
Mailing Address - Country:US
Mailing Address - Phone:214-929-1676
Mailing Address - Fax:214-377-4244
Practice Address - Street 1:709 BUSINESS WAY STE 120
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-3961
Practice Address - Country:US
Practice Address - Phone:972-559-4437
Practice Address - Fax:214-377-4244
Is Sole Proprietor?:No
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120773235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist