Provider Demographics
NPI:1639777907
Name:WAHL, CASANDRA CONLEE (AUD)
Entity Type:Individual
Prefix:
First Name:CASANDRA
Middle Name:CONLEE
Last Name:WAHL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:CASANDRA
Other - Middle Name:L
Other - Last Name:CONLEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:1528 NORTHWAY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1287
Mailing Address - Country:US
Mailing Address - Phone:320-252-0233
Mailing Address - Fax:320-252-1421
Practice Address - Street 1:1528 NORTHWAY DR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1287
Practice Address - Country:US
Practice Address - Phone:320-252-0233
Practice Address - Fax:320-252-1421
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10258231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist