MEDICARE: CASSANDRA TUNNEY CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist
2	235Z00000X	Speech-Language Pathologist	SP-2564	NV

General Provider Information

NPI Number	:	1487175865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA TUNNEY CCC-SLP

Provider Business Mailing Address
First Line	:	7960 RAFAEL RIVERA WAY UNIT 1117
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-5346
Country	:	US
Telephone Number	:	201-491-3315
Fax Number	:

Provider Business Practice Location Address
First Line	:	5516 S FORT APACHE RD STE 130
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-7679
Country	:	US
Telephone Number	:	702-641-8255
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2017
Last Update Date	:	08/27/2019

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Directions to “ CASSANDRA TUNNEY CCC-SLP” Practice Location

Language	Start Address	Practice Location

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