Provider Demographics
NPI:1730467309
Name:LANDRUM, CASSANDRA JOY (MED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:JOY
Last Name:LANDRUM
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:MS
Other - First Name:CASSANDRA
Other - Middle Name:JOY
Other - Last Name:ECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, CCC-SLP
Mailing Address - Street 1:1102 MONTVALE CIR
Mailing Address - Street 2:
Mailing Address - City:SIGNAL MTN
Mailing Address - State:TN
Mailing Address - Zip Code:37377
Mailing Address - Country:US
Mailing Address - Phone:678-925-3502
Mailing Address - Fax:
Practice Address - Street 1:1102 MONTVALE CIR
Practice Address - Street 2:
Practice Address - City:SIGNAL MTN
Practice Address - State:TN
Practice Address - Zip Code:37377
Practice Address - Country:US
Practice Address - Phone:678-925-3502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-29
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
TN7306235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist