Provider Demographics
NPI:1811445422
Name:MOBERG, CASSANDRA (SLP)
Entity type:Individual
Prefix:MISS
First Name:CASSANDRA
Middle Name:
Last Name:MOBERG
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MRS
Other - First Name:CASSANDRA
Other - Middle Name:LYNN
Other - Last Name:BARRETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:275 RIVER VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-6369
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:275 RIVER VILLAGE DR
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-6369
Practice Address - Country:US
Practice Address - Phone:775-450-4855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-282235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist