Provider Demographics
NPI:1710981592
Name:KASSI, JOHN M (CCC-SLP-L)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:KASSI
Suffix:
Gender:M
Credentials:CCC-SLP-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 12TH ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323-1440
Mailing Address - Country:US
Mailing Address - Phone:814-437-5600
Mailing Address - Fax:814-432-7400
Practice Address - Street 1:631 12TH ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323-1440
Practice Address - Country:US
Practice Address - Phone:814-437-5600
Practice Address - Fax:814-432-7400
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL000964L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018803870001Medicaid
PA208593OtherUPMC GROUP PROV. #
PA385043OtherHEALTH AMERICA INDIV. #
PA232982433001OtherTRICARE GROUP PROV. #
PA0018803960002Medicaid
PA262033OtherHIGHMARK INDIV. PROV. #
PA340583OtherHEALTH AMERICA GROUP #
PA396760Medicare ID - Type UnspecifiedPROVIDER NUMBER