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General NPI Number Information
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NPI Number | 1891453965
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Entity Type | Individual
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Provider Name | KASSIE ENGDAHL M.S. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 12/06/2021
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Last Update Date | 12/06/2021
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Provider Practice Location Address
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Address Line | 2400 LAS GALLINAS AVE STE 135A
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City | SAN RAFAEL
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State | CA
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Zip | 94903-1452
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Country | US
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Telephone | 415-326-3315
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Fax |
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Provider Business Mailing Address
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Address Line | 1311 MARTIN LUTHER KING JR WAY APT 2
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City | BERKELEY
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State | CA
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Zip | 94709-1951
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Country | US
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Telephone | 206-518-3406
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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 |
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