Provider Demographics
NPI:1376054486
Name:KANNER, CARA LESLIE (MA)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:LESLIE
Last Name:KANNER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4675 STONE RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-3030
Mailing Address - Country:US
Mailing Address - Phone:702-285-2970
Mailing Address - Fax:
Practice Address - Street 1:4675 STONE RIDGE TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-3030
Practice Address - Country:US
Practice Address - Phone:702-285-2970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9964235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist