Individual
CASSIDY PHOENIX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
37 OCEANIC LN, LAKE HAVASU CITY, AZ 86403-5434
(702) 501-1143
Mailing address
3887 BLUEGRASS DR, LAKE HAVASU CITY, AZ 86406-4362
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
Primary
SLPA10517
AZ
Other
Enumeration date
04/12/2017
Last updated
05/25/2021
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