Provider Demographics
NPI:1720758477
Name:ADAMICK, CASSIDY MICHELLE (SLP INTERN)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:MICHELLE
Last Name:ADAMICK
Suffix:
Gender:F
Credentials:SLP INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GABRIELS BLUFF DR APT 4106
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-1879
Mailing Address - Country:US
Mailing Address - Phone:254-709-4864
Mailing Address - Fax:
Practice Address - Street 1:9901 N CAPITAL OF TEXAS HWY STE 250
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5977
Practice Address - Country:US
Practice Address - Phone:512-887-2126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123153235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX41994OtherSPEECH LANGUAGE PATHOLOGIST ASSISTANT