Provider Demographics
NPI:1386114122
Name:KANDAH, CASSANDRA CHRISTINE (PHD)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:CHRISTINE
Last Name:KANDAH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:CHRISTINE
Other - Last Name:LOACANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2729 N MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-1930
Mailing Address - Country:US
Mailing Address - Phone:248-495-8165
Mailing Address - Fax:
Practice Address - Street 1:200 W MADISON ST STE 2100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-3521
Practice Address - Country:US
Practice Address - Phone:248-495-8165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-04
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Single Specialty
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation