Provider Demographics
NPI:1811449762
Name:CARRASCO, CASSANDRA RENEE
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:RENEE
Last Name:CARRASCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14207 HIGGINS RD.
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217
Mailing Address - Country:US
Mailing Address - Phone:575-635-5068
Mailing Address - Fax:575-826-7887
Practice Address - Street 1:14207 HIGGINS RD.
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217
Practice Address - Country:US
Practice Address - Phone:575-635-5068
Practice Address - Fax:575-826-7887
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2023-05-09
Deactivation Date:2019-08-22
Deactivation Code:
Reactivation Date:2022-08-11
Provider Licenses
StateLicense IDTaxonomies
TX119838235Z00000X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No172V00000XOther Service ProvidersCommunity Health Worker