Provider Demographics
NPI:1962920058
Name:BETANCOURT, CASSANDRA CRYSTAL (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:CRYSTAL
Last Name:BETANCOURT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3004 N CLOSNER BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-7237
Mailing Address - Country:US
Mailing Address - Phone:956-287-0460
Mailing Address - Fax:
Practice Address - Street 1:3004 N CLOSNER BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78541-7237
Practice Address - Country:US
Practice Address - Phone:956-287-0460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112780235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist