Provider Demographics
NPI:1538890835
Name:JACKSON, CASSIDY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:CASSIDY
Other - Middle Name:
Other - Last Name:SIWIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:105 WATSON DR
Mailing Address - Street 2:
Mailing Address - City:WARRENDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15086-1110
Mailing Address - Country:US
Mailing Address - Phone:412-552-9578
Mailing Address - Fax:
Practice Address - Street 1:131 DRUMLIN CT
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1863
Practice Address - Country:US
Practice Address - Phone:315-332-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-19
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11152235Z00000X
NY035435235Z00000X
PA016376235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist