Provider Demographics
NPI:1891730263
Name:PRIVETTE-CASSADY, WENDY LYNN (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:LYNN
Last Name:PRIVETTE-CASSADY
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 1:191 IRELAND
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-4163
Mailing Address - Country:US
Mailing Address - Phone:479-306-4477
Mailing Address - Fax:
Practice Address - Street 1:191 IRELAND
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-4163
Practice Address - Country:US
Practice Address - Phone:479-530-6025
Practice Address - Fax:479-419-5595
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1659235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist