Provider Demographics
NPI:1386477370
Name:RYAN, CASSIE MICHELLE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:MICHELLE
Last Name:RYAN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 GERALD ST
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77378-3403
Mailing Address - Country:US
Mailing Address - Phone:936-890-3264
Mailing Address - Fax:
Practice Address - Street 1:701 GERALD ST
Practice Address - Street 2:
Practice Address - City:WILLIS
Practice Address - State:TX
Practice Address - Zip Code:77378-3403
Practice Address - Country:US
Practice Address - Phone:936-890-3264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121645235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist