Provider Demographics
NPI:1346627288
Name:GUBNITSKY, CASSANDRA MICHELLE (MA)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:MICHELLE
Last Name:GUBNITSKY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:MICHELLE
Other - Last Name:GUBNITSKY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:2685 EXECUTIVE PARK DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3651
Mailing Address - Country:US
Mailing Address - Phone:954-217-3977
Mailing Address - Fax:
Practice Address - Street 1:2685 EXECUTIVE PARK DR
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3651
Practice Address - Country:US
Practice Address - Phone:954-217-3977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ6840235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist