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General NPI Number Information
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NPI Number | 1194567446
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Entity Type | Individual
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Provider Name | ALYSSA DANA KASS CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 06/08/2024
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Last Update Date | 06/08/2024
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Provider Practice Location Address
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Address Line | 30495 CANWOOD ST STE 216
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City | AGOURA HILLS
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State | CA
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Zip | 91301-4331
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Country | US
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Telephone | 805-991-7373
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Fax |
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Provider Business Mailing Address
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Address Line | 1644 CAMBERWELL PL
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361-1507
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Country | US
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Telephone | 818-903-3555
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP16534
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License Number State | CA
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