Provider Demographics
NPI:1861120826
Name:CASSIDAY, HANNAH LEE (MA CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:HANNAH
Middle Name:LEE
Last Name:CASSIDAY
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28673 W GREENLEAF PL
Mailing Address - Street 2:
Mailing Address - City:SPRING GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60081-9231
Mailing Address - Country:US
Mailing Address - Phone:815-814-8797
Mailing Address - Fax:
Practice Address - Street 1:805 E IRVING PARK RD STE D
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-4320
Practice Address - Country:US
Practice Address - Phone:331-465-9440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14412123235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist