Provider Demographics
NPI:1164753224
Name:QUINN, CASSONDRA (SLP)
Entity Type:Individual
Prefix:
First Name:CASSONDRA
Middle Name:
Last Name:QUINN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 NE 145TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-8914
Mailing Address - Country:US
Mailing Address - Phone:360-921-4596
Mailing Address - Fax:
Practice Address - Street 1:724 SW HARRISON ST
Practice Address - Street 2:NEUBERGER HALL 93
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-3295
Practice Address - Country:US
Practice Address - Phone:503-725-3584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-28
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00003668235Z00000X
OR15108235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist