Healthcare Provider Details

I. General information

NPI: 1003799875
Provider Name (Legal Business Name): CASSIDY JAMISON MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3090 N ACADEMY BLVD
COLORADO SPRINGS CO
80917-5368
US

IV. Provider business mailing address

4977 TRUSCOTT RD
COLORADO SPRINGS CO
80925-1527
US

V. Phone/Fax

Practice location:
  • Phone: 719-574-8300
  • Fax:
Mailing address:
  • Phone: 270-634-1505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberMSSLP.0000031
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: