Provider Demographics
NPI:1093228371
Name:GREENE, CASSONDRA ELAINE (CF-SLP)
Entity Type:Individual
Prefix:
First Name:CASSONDRA
Middle Name:ELAINE
Last Name:GREENE
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 QUILLIAN ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30528-1464
Mailing Address - Country:US
Mailing Address - Phone:706-242-8247
Mailing Address - Fax:
Practice Address - Street 1:273 QUILLIAN ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:GA
Practice Address - Zip Code:30528-1464
Practice Address - Country:US
Practice Address - Phone:706-865-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET003758235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist