Provider Demographics
NPI:1578305066
Name:KASDAN, SHAYNA SOPHIA (MA)
Entity type:Individual
Prefix:
First Name:SHAYNA
Middle Name:SOPHIA
Last Name:KASDAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2298
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-2298
Mailing Address - Country:US
Mailing Address - Phone:541-557-1892
Mailing Address - Fax:
Practice Address - Street 1:923 NW GRANT AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4503
Practice Address - Country:US
Practice Address - Phone:541-557-1892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor