Provider Demographics
NPI:1316764798
Name:JOHNSON, CASSAUNDRA RENEE
Entity type:Individual
Prefix:
First Name:CASSAUNDRA
Middle Name:RENEE
Last Name:JOHNSON
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 1:14021 SUSIE LN # B
Mailing Address - Street 2:
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-9371
Mailing Address - Country:US
Mailing Address - Phone:281-300-7925
Mailing Address - Fax:
Practice Address - Street 1:14021 SUSIE LN # B
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-9371
Practice Address - Country:US
Practice Address - Phone:281-300-7925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23041505172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker