Provider Demographics
NPI:1144019027
Name:SUTTLE, KASSONDRA MARIE
Entity type:Individual
Prefix:
First Name:KASSONDRA
Middle Name:MARIE
Last Name:SUTTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KASSONDRA
Other - Middle Name:MARIE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:847 17TH ST NE
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-4850
Mailing Address - Country:US
Mailing Address - Phone:330-323-1945
Mailing Address - Fax:
Practice Address - Street 1:847 17TH ST NE
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-4850
Practice Address - Country:US
Practice Address - Phone:330-323-1945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant