Provider Demographics
NPI:1003066333
Name:LIDIN, CASSANDRA A (MAC,LAC,DIPLAC)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:A
Last Name:LIDIN
Suffix:
Gender:F
Credentials:MAC,LAC,DIPLAC
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:A
Other - Last Name:LIDIN-LAMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5432 E. NORTHERN LIGHTS BLVD.
Mailing Address - Street 2:STE. 407
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508
Mailing Address - Country:US
Mailing Address - Phone:907-726-7070
Mailing Address - Fax:907-337-0493
Practice Address - Street 1:700 W. 41ST AVE.,
Practice Address - Street 2:STE 101
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503
Practice Address - Country:US
Practice Address - Phone:907-726-7070
Practice Address - Fax:907-337-0493
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKA120171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist