Provider Demographics
NPI:1265319966
Name:CANNON, KA'DASIA
Entity type:Individual
Prefix:
First Name:KA'DASIA
Middle Name:
Last Name:CANNON
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 1:600 SUPERIOR AVE STE 2610
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-2692
Mailing Address - Country:US
Mailing Address - Phone:440-819-1603
Mailing Address - Fax:
Practice Address - Street 1:600 SUPERIOR AVE STE 2610
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-2692
Practice Address - Country:US
Practice Address - Phone:440-819-1603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator