Provider Demographics
NPI:1497283840
Name:LASSONDE, KASANDRA MARIE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KASANDRA
Middle Name:MARIE
Last Name:LASSONDE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:KASANDRA
Other - Middle Name:MARIE
Other - Last Name:CEDERGREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11045 MYERON RD N
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-8565
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2650 65TH AVE
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:WI
Practice Address - Zip Code:54020-4370
Practice Address - Country:US
Practice Address - Phone:715-294-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-30
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4454235Z00000X
WI4454-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist