Provider Demographics
NPI:1215453154
Name:BREWER, CASANDRA (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CASANDRA
Middle Name:
Last Name:BREWER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:CASANDRA
Other - Middle Name:
Other - Last Name:BREDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:137 SW 95TH RD
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-8160
Mailing Address - Country:US
Mailing Address - Phone:187-442-9715
Mailing Address - Fax:
Practice Address - Street 1:809 S 8TH ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MO
Practice Address - Zip Code:64735-2907
Practice Address - Country:US
Practice Address - Phone:660-885-5585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
MO2017029232235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1215453154Medicaid