Provider Demographics
NPI:1255670428
Name:STARBUCK, CASSANDRA ROCHELLE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:ROCHELLE
Last Name:STARBUCK
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MISS
Other - First Name:CASSANDRA
Other - Middle Name:ROCHELLE
Other - Last Name:RETZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4140 OLD MILL PKWY
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-6550
Mailing Address - Country:US
Mailing Address - Phone:636-926-2700
Mailing Address - Fax:
Practice Address - Street 1:4140 OLD MILL PKWY
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-6550
Practice Address - Country:US
Practice Address - Phone:636-926-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010032834235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist