Healthcare Provider Details

I. General information

NPI: 1679053250
Provider Name (Legal Business Name): CASSANDRA CANNON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3626 FAIR OAKS BLVD STE 100
SACRAMENTO CA
95864-7200
US

IV. Provider business mailing address

3626 FAIR OAKS BLVD STE 100
SACRAMENTO CA
95864-7200
US

V. Phone/Fax

Practice location:
  • Phone: 858-367-3368
  • Fax:
Mailing address:
  • Phone: 858-367-3368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY24315
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: