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NPI Code Detail

MEDICARE: CASSIDY SMITH

MEDICARE: CASSIDY SMITH
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1205595824
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASSIDY SMITH
Provider Business Mailing Address
First Line : 4335 BLAISDELL AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55409-2012
Country : US
Telephone Number : 262-224-9771
Fax Number :
Provider Business Practice Location Address
First Line : 1345 MENDOTA HEIGHTS RD STE 400
Second Line :
City : MENDOTA HEIGHTS
State : MN
Zip : 55120-2008
Country : US
Telephone Number : 612-201-2468
Fax Number : 949-564-6112
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/10/2021
Last Update Date : 04/17/2026

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Directions to “ CASSIDY SMITH ” Practice Location

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