Provider Demographics
NPI:1053937441
Name:WHITE, CASSIDY (AUD)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 W CLEARWATER AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-5028
Mailing Address - Country:US
Mailing Address - Phone:509-736-4005
Mailing Address - Fax:509-737-9525
Practice Address - Street 1:4015 W CLEARWATER AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-5028
Practice Address - Country:US
Practice Address - Phone:509-736-4005
Practice Address - Fax:509-737-9525
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA12387231H00000X
WALD61322664231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist