Provider Demographics
NPI:1932598125
Name:PETERS-JOHNSON, CASSANDRA (PHD, CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:
Last Name:PETERS-JOHNSON
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10607 GREAT ARBOR DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-4220
Mailing Address - Country:US
Mailing Address - Phone:301-613-1986
Mailing Address - Fax:301-765-9558
Practice Address - Street 1:10607 GREAT ARBOR DR
Practice Address - Street 2:SUITE B
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-4220
Practice Address - Country:US
Practice Address - Phone:301-613-1986
Practice Address - Fax:301-765-9558
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC000299235Z00000X
MD00685235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD00172254OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOC
DC000299OtherDC HEALTH & REGULATION LICENSING ADMINISTRATION BOARD OF AUD & SPEECH-LANG PATH
MD00685OtherBOARD OF EXAMINERS FOR AUDS, HADS, AND SLPS
DC056838900Medicare PIN