Provider Demographics
NPI:1528154085
Name:CANN, KIIJUANA L
Entity type:Individual
Prefix:MRS
First Name:KIIJUANA
Middle Name:L
Last Name:CANN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KIIJUANA
Other - Middle Name:L
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:640 S. STATE STREET
Mailing Address - Street 2:MAIL CODE 3055
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-3530
Mailing Address - Country:US
Mailing Address - Phone:302-480-1688
Mailing Address - Fax:302-480-9807
Practice Address - Street 1:826 S GOVERNORS AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-4107
Practice Address - Country:US
Practice Address - Phone:302-674-3752
Practice Address - Fax:302-674-8521
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE02-0000091231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG02445H01Medicare PIN