Provider Demographics
NPI:1447974753
Name:COLLIER, CASSIDY DIANNE (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:DIANNE
Last Name:COLLIER
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 CARTER ST
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:61432-5031
Mailing Address - Country:US
Mailing Address - Phone:309-371-2033
Mailing Address - Fax:
Practice Address - Street 1:1490 E MYRTLE ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:IL
Practice Address - Zip Code:61520-1519
Practice Address - Country:US
Practice Address - Phone:309-647-0136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1218469235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist