Healthcare Provider Details

I. General information

NPI: 1710981592
Provider Name (Legal Business Name): JOHN M. KASSI CCC-SLP-L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 12TH ST
FRANKLIN PA
16323-1440
US

IV. Provider business mailing address

631 12TH ST
FRANKLIN PA
16323-1440
US

V. Phone/Fax

Practice location:
  • Phone: 814-437-5600
  • Fax: 814-432-7400
Mailing address:
  • Phone: 814-437-5600
  • Fax: 814-432-7400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL000964L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: