Provider Demographics
NPI:1053687822
Name:SASKEN, KASANDRA (LMP)
Entity Type:Individual
Prefix:MRS
First Name:KASANDRA
Middle Name:
Last Name:SASKEN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5177 LABOUNTY RD
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-8917
Mailing Address - Country:US
Mailing Address - Phone:360-380-2537
Mailing Address - Fax:360-380-1814
Practice Address - Street 1:2076 MAIN ST # 4
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-9468
Practice Address - Country:US
Practice Address - Phone:360-380-2537
Practice Address - Fax:360-380-1814
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00008338225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA108196OtherDEPT. OF LABOR AND INDUSTRIES
WA42574OtherREGENCE BLUESHIELD