Provider Demographics
NPI:1053029520
Name:TENNEY, CASSANDRA CAROL (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:CAROL
Last Name:TENNEY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 VILLAGE SQ STE 210
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-1624
Mailing Address - Country:US
Mailing Address - Phone:614-834-1114
Mailing Address - Fax:614-987-8643
Practice Address - Street 1:6355 WINCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-2068
Practice Address - Country:US
Practice Address - Phone:614-834-1114
Practice Address - Fax:614-987-8643
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14480240235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist