MEDICARE: CASSIES KIDS CLINIC

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
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1801519848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASSIES KIDS CLINIC

Provider Business Mailing Address
First Line	:	5707 HIGHWAY 7 APT 119
Second Line	:
City	:	SAINT LOUIS PARK
State	:	MN
Zip	:	55416-2391
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5707 HIGHWAY 7 APT 119
Second Line	:
City	:	SAINT LOUIS PARK
State	:	MN
Zip	:	55416-2391
Country	:	US
Telephone Number	:	630-561-4714
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CASSIE RIO
Credential	:
Telephone Number	:	630-561-4714

Provider Enumeration Date	:	09/23/2022
Last Update Date	:	09/23/2022

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Directions to “CASSIES KIDS CLINIC ” Practice Location

Language	Start Address	Practice Location

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