Basic Information
| Provider Information | |||||||||
| NPI: | 1497283840 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LASSONDE | ||||||||
| FirstName: | KASANDRA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | CCC-SLP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | CEDERGREN | ||||||||
| OtherFirstName: | KASANDRA | ||||||||
| OtherMiddleName: | MARIE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 11045 MYERON RD N | ||||||||
| Address2: | |||||||||
| City: | STILLWATER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550828565 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2650 65TH AVE | ||||||||
| Address2: | |||||||||
| City: | OSCEOLA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 540204370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7152941100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2017 | ||||||||
| LastUpdateDate: | 11/01/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 4454 | WI | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 4454-154 | WI | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.