Provider Demographics
NPI:1205129210
Name:KASSOVER, KENNETH L (PHD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:L
Last Name:KASSOVER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 AURORA AVE N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-7379
Mailing Address - Country:US
Mailing Address - Phone:206-859-5030
Mailing Address - Fax:206-859-5031
Practice Address - Street 1:4300 AURORA AVE N
Practice Address - Street 2:SUITE 100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-7379
Practice Address - Country:US
Practice Address - Phone:206-859-5030
Practice Address - Fax:206-859-5031
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist