Healthcare Provider Details

I. General information

NPI: 1114548740
Provider Name (Legal Business Name): CASSANDRA JONES MORGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2020
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7808 PACIFIC AVE UNIT 9
TACOMA WA
98408-7039
US

IV. Provider business mailing address

2008 104TH ST S APT S104
TACOMA WA
98444-6789
US

V. Phone/Fax

Practice location:
  • Phone: 559-265-2209
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number61458346
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: