Provider Demographics
NPI:1114746229
Name:SPENO, CASSANDRA JOAN
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:JOAN
Last Name:SPENO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4039 WILLIFORD WAY
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-6224
Mailing Address - Country:US
Mailing Address - Phone:615-364-9293
Mailing Address - Fax:
Practice Address - Street 1:6116 SHALLOWFORD RD STE 119
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7202
Practice Address - Country:US
Practice Address - Phone:423-556-3714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician