Provider Demographics
NPI:1245642958
Name:POPLAWSKI, KASSANDRA RENEE (HIS)
Entity type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:RENEE
Last Name:POPLAWSKI
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:KASSANDRA
Other - Middle Name:RENEE
Other - Last Name:WOODCOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HIS
Mailing Address - Street 1:112 E 90TH DR
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410
Mailing Address - Country:US
Mailing Address - Phone:219-525-4485
Mailing Address - Fax:219-473-0633
Practice Address - Street 1:112 E 90TH DR
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410
Practice Address - Country:US
Practice Address - Phone:219-525-4485
Practice Address - Fax:219-473-0633
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001344A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist