Provider Demographics
NPI:1891453965
Name:ENGDAHL, KASSIE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KASSIE
Middle Name:
Last Name:ENGDAHL
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 MARTIN LUTHER KING JR WAY APT 2
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-1951
Mailing Address - Country:US
Mailing Address - Phone:206-518-3406
Mailing Address - Fax:
Practice Address - Street 1:2400 LAS GALLINAS AVE STE 135A
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-1452
Practice Address - Country:US
Practice Address - Phone:415-326-3315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist