Provider Demographics
NPI:1346621729
Name:CASSIDY, MELISSA J (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:J
Last Name:CASSIDY
Suffix:
Gender:
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:J
Other - Last Name:BIERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4495 LAKE AVE S APT 324
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3479
Mailing Address - Country:US
Mailing Address - Phone:616-403-8119
Mailing Address - Fax:
Practice Address - Street 1:1030 MINERS RD STE C
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9709
Practice Address - Country:US
Practice Address - Phone:269-235-9083
Practice Address - Fax:269-359-3735
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9467235Z00000X
MI7101006855235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist