MEDICARE: CASSANDRA KELLOGG

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	390200000X	Student in an Organized Health Care Education/Training Program	IN0010388	WV

General Provider Information

NPI Number	:	1669316089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA KELLOGG

Provider Business Mailing Address
First Line	:	192 MILEW DR
Second Line	:
City	:	IRONTON
State	:	OH
Zip	:	45638-8086
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2402 ADAMS AVE
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25704-1399
Country	:	US
Telephone Number	:	304-429-6716
Fax Number	:

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

Provider Enumeration Date	:	04/16/2026
Last Update Date	:	04/16/2026

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Directions to “ CASSANDRA KELLOGG ” Practice Location

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