Provider Demographics
NPI:1821639600
Name:ENG, CASSANDRA DEE
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:DEE
Last Name:ENG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:1130 SE THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-2676
Mailing Address - Country:US
Mailing Address - Phone:509-952-9505
Mailing Address - Fax:
Practice Address - Street 1:315 SE CRESTVIEW ST
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-2264
Practice Address - Country:US
Practice Address - Phone:509-334-3411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60977082235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist