Provider Demographics
NPI:1699043760
Name:WHITEHEAD, CASSANDRA ANNETTE
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:ANNETTE
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 GASLIGHT MEDICAL PKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3147
Mailing Address - Country:US
Mailing Address - Phone:936-699-3141
Mailing Address - Fax:936-699-3145
Practice Address - Street 1:121 GASLIGHT MEDICAL PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3147
Practice Address - Country:US
Practice Address - Phone:936-699-3141
Practice Address - Fax:936-699-3145
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80478237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist