Healthcare Provider Details

I. General information

NPI: 1386114122
Provider Name (Legal Business Name): CASSANDRA CHRISTINE KANDAH PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CASSANDRA CHRISTINE LOACANO

II. Dates (important events)

Enumeration Date: 12/04/2018
Last Update Date: 04/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W MADISON ST STE 2100
CHICAGO IL
60606-3521
US

IV. Provider business mailing address

2729 N MAPLEWOOD AVE
CHICAGO IL
60647-1930
US

V. Phone/Fax

Practice location:
  • Phone: 248-495-8165
  • Fax:
Mailing address:
  • Phone: 248-495-8165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: