Provider Demographics
NPI:1881464774
Name:WILLIAMS, CASSIDY BROOKE (SLP-A)
Entity type:Individual
Prefix:MS
First Name:CASSIDY
Middle Name:BROOKE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:MRS
Other - First Name:CASSIDY
Other - Middle Name:BROOKE
Other - Last Name:CALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP-A
Mailing Address - Street 1:172 DARE BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMDENTON
Mailing Address - State:MO
Mailing Address - Zip Code:65020-5558
Mailing Address - Country:US
Mailing Address - Phone:573-346-5651
Mailing Address - Fax:
Practice Address - Street 1:172 DARE BLVD
Practice Address - Street 2:
Practice Address - City:CAMDENTON
Practice Address - State:MO
Practice Address - Zip Code:65020-5558
Practice Address - Country:US
Practice Address - Phone:573-346-5651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20220456382355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant