Healthcare Provider Details

I. General information

NPI: 1487518320
Provider Name (Legal Business Name): KASSANDRA HARGENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1072 HWY 210 B
SNEADS FERRY NC
28460
US

IV. Provider business mailing address

133 FARMINGTON DR
RICHLANDS NC
28574-7453
US

V. Phone/Fax

Practice location:
  • Phone: 910-358-3445
  • Fax:
Mailing address:
  • Phone: 910-358-3445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number01002
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: