Provider Demographics
NPI:1164754438
Name:POOLE, CASSANDRA (SLP)
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:
Last Name:POOLE
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:PO BOX 831
Mailing Address - Street 2:
Mailing Address - City:MADILL
Mailing Address - State:OK
Mailing Address - Zip Code:73446-0831
Mailing Address - Country:US
Mailing Address - Phone:866-795-3301
Mailing Address - Fax:580-795-7307
Practice Address - Street 1:16001 LAKESHORE VILLA DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-1336
Practice Address - Country:US
Practice Address - Phone:813-313-7120
Practice Address - Fax:813-868-3478
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA3254235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist