Provider Demographics
NPI:1093379844
Name:KAVEH, CASSANDRA CHANNELL
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:CHANNELL
Last Name:KAVEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 BUCKSKIN RD
Mailing Address - Street 2:
Mailing Address - City:BELL CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1123
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:98 BUCKSKIN RD
Practice Address - Street 2:
Practice Address - City:BELL CANYON
Practice Address - State:CA
Practice Address - Zip Code:91307-1123
Practice Address - Country:US
Practice Address - Phone:323-209-5966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant