1538832316 NPI number — MRS. CRESCENCIA DENISE CASSITY LPC

Table of content: MRS. CRESCENCIA DENISE CASSITY LPC (NPI 1538832316)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538832316 NPI number — MRS. CRESCENCIA DENISE CASSITY LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASSITY
Provider First Name:
CRESCENCIA
Provider Middle Name:
DENISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAMPSON
Provider Other First Name:
CRESCENCIA
Provider Other Middle Name:
DENISE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538832316
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 189
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAC DU FLAMBEAU
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54538-0189
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-588-1511
Provider Business Mailing Address Fax Number:
715-588-3903

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
533 PEACE PIPE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAC DU FLAMBEAU
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54538-9123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-588-1511
Provider Business Practice Location Address Fax Number:
715-588-3903
Provider Enumeration Date:
07/28/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  10531-125 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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