Provider Demographics
NPI:1225863103
Name:DOUGHERTY, CASSIDY (MS)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:CASSIDY
Other - Middle Name:
Other - Last Name:NICOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:90 HOWARD DR
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-8138
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 METROPLEX DR STE 308
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-3148
Practice Address - Country:US
Practice Address - Phone:615-652-1084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist