Healthcare Provider Details

I. General information

NPI: 1033046859
Provider Name (Legal Business Name): KASSANDRA BAKER S KASSANDRA BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 LARCHWOOD RD
MANSFIELD OH
44907-2424
US

IV. Provider business mailing address

992 S MAIN ST APT 8A
MANSFIELD OH
44907-3307
US

V. Phone/Fax

Practice location:
  • Phone: 419-747-4122
  • Fax: 419-747-4126
Mailing address:
  • Phone: 567-756-7259
  • Fax: 567-756-7259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: