MEDICARE: MRS. CASSANDRA NICHOLAS M. ED., ED. S., NCSP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist	00882	OH

General Provider Information

NPI Number	:	1881538007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CASSANDRA NICHOLAS M. ED., ED. S., NCSP

Provider Business Mailing Address
First Line	:	3205 SHREVE RD
Second Line	:
City	:	WOOSTER
State	:	OH
Zip	:	44691-4439
Country	:	US
Telephone Number	:	330-264-8685
Fax Number	:

Provider Business Practice Location Address
First Line	:	3205 SHREVE RD
Second Line	:
City	:	WOOSTER
State	:	OH
Zip	:	44691-4439
Country	:	US
Telephone Number	:	330-264-8685
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2026
Last Update Date	:	04/17/2026

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