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General NPI Number Information
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NPI Number | 1346621729
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Entity Type | Individual
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Provider Name | MELISSA J CASSIDY MA CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 06/11/2015
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 1030 MINERS RD STE C
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-9709
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Country | US
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Telephone | 269-235-9083
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Fax | 269-359-3735
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Provider Business Mailing Address
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Address Line | 4495 LAKE AVE S APT 324
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City | WHITE BEAR LAKE
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State | MN
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Zip | 55110-3479
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Country | US
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Telephone | 616-403-8119
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 9467
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 7101006855
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License Number State | MI
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