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NPI Code Detail

MEDICARE: MELISSA J CASSIDY MA CCC-SLP

MEDICARE: MELISSA J CASSIDY MA CCC-SLP
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
1235Z00000XSpeech-Language PathologistSLP.LL.70121302WA
2235Z00000XSpeech-Language Pathologist9467MN
3235Z00000XSpeech-Language Pathologist7101006855MI

General Provider Information

NPI Number : 1346621729
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA J CASSIDY MA CCC-SLP
Provider Business Mailing Address
First Line : 4495 LAKE AVE S APT 324
Second Line :
City : WHITE BEAR LAKE
State : MN
Zip : 55110-3479
Country : US
Telephone Number : 616-403-8119
Fax Number :
Provider Business Practice Location Address
First Line : 1030 MINERS RD STE C
Second Line :
City : SAINT JOSEPH
State : MI
Zip : 49085-9709
Country : US
Telephone Number : 269-235-9083
Fax Number : 269-359-3735
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2015
Last Update Date : 05/15/2026

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Directions to “ MELISSA J CASSIDY MA CCC-SLP” Practice Location

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