Provider Demographics
NPI:1134424153
Name:RICHARDSON, KASANDRA C (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KASANDRA
Middle Name:C
Last Name:RICHARDSON
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 1:804 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39773-3137
Mailing Address - Country:US
Mailing Address - Phone:662-494-2006
Mailing Address - Fax:
Practice Address - Street 1:804 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773-3137
Practice Address - Country:US
Practice Address - Phone:662-494-2006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-22
Last Update Date:2011-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3302235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist