Individual provider Active NPI

Cassaundra Sutton, CCC-SLP

  • Speech-Language Pathologist
  • Maryville, TN
National Provider Identifier
1205447646
Registry record updated Sep 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
6982 Issued in TN
Practice address
2030 Chilhowee Medical Park
Maryville, TN 37804-5285
Phone
(865) 982-3400
NPI assigned
Aug 10, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 6982 TN Primary

Addresses

Primary practice location

2030 Chilhowee Medical Park
Maryville, TN 37804-5285

Mailing address

PO Box 5209
Maryville, TN 37802-5209
Phone (865) 982-3400

Other identifiers 1

IdentifierTypeStateIssuer
Q060036MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220218000847 TN Practitioner - Qualified Speech Language Pathologist 3577957406 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Functional Pathways Preferred of Tennessee LLC Speech-Language Pathologist CurrentSince Aug 16, 2024 Accepting new patients
Healthpro Heritage Rehab & Fitness, LLC Speech-Language Pathologist CurrentSince Jan 14, 2022 Accepting new patients
Healthpro Heritage Rehab & Fitness, LLC Speech-Language Pathologist CurrentSince Jan 14, 2022 Accepting new patients
Speech Pathology Services of East Tennessee LLC Speech-Language Pathologist PastSince Aug 16, 2020 Accepting new patients
Little Tennessee Valley Educational Cooperative PastSince Aug 16, 2020 Accepting new patients

Locations

960 S Seivers Blvd
Clinton, TN 37716
Phone (865) 270-3178

10133 Sherrill Blvd
Ste 200
Knoxville, TN 37932
Phone (865) 392-2847

155 Morning Point Dr
Lenoir City, TN 37772
Phone (865) 230-1500

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1597017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599091200000",
    "number": "1205447646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5209",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378025209",
            "telephone_number": "865-982-3400",
            "fax_number": "865-238-2034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2030 CHILHOWEE MEDICAL PARK",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378045285",
            "telephone_number": "865-982-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUTTON",
        "first_name": "CASSAUNDRA",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-10",
        "last_updated": "2020-09-03",
        "certification_date": "2020-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TN",
            "license": "6982",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q060036",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maryville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.