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General NPI Number Information
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NPI Number | 1760980783
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Entity Type | Individual
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Provider Name | TARA M CASSANO M.S., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 01/24/2018
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Last Update Date | 01/10/2024
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Provider Practice Location Address
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Address Line | 3975 CONSHOHOCKEN AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19131-5484
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Country | US
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Telephone | 267-292-6009
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Fax |
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Provider Business Mailing Address
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Address Line | 619 S TANEY ST
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City | PHILADELPHIA
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State | PA
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Zip | 19146-1046
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Country | US
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Telephone | 856-371-0726
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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 |
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License Number State | MD
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