Healthcare Provider Details

I. General information

NPI: 1720912694
Provider Name (Legal Business Name): CASSIDY MARIE RIVAS RODRIGUEZ CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 E JEFFERSON BLVD
SOUTH BEND IN
46615-2635
US

IV. Provider business mailing address

751 GREENVIEW AVE
SOUTH BEND IN
46619-2708
US

V. Phone/Fax

Practice location:
  • Phone: 574-289-4831
  • Fax:
Mailing address:
  • Phone: 574-540-7378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: