Healthcare Provider Details

I. General information

NPI: 1093637795
Provider Name (Legal Business Name): CASSANDRA BABCOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4265 HALKIRK DR
WATERFORD MI
48329-1629
US

IV. Provider business mailing address

4265 HALKIRK DR
WATERFORD MI
48329-1629
US

V. Phone/Fax

Practice location:
  • Phone: 248-623-9167
  • Fax:
Mailing address:
  • Phone: 248-623-9660
  • Fax: 248-623-9167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number945514
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: