Provider Demographics
NPI:1588906622
Name:CASSIS, NICHOLE
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:CASSIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14907 ALPINE BAY LOOP
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-2808
Mailing Address - Country:US
Mailing Address - Phone:703-565-8000
Mailing Address - Fax:
Practice Address - Street 1:901 N MONROE ST
Practice Address - Street 2:UNIT 502
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-2353
Practice Address - Country:US
Practice Address - Phone:703-565-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004633235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist