Provider Demographics
NPI:1043811904
Name:CHAGNON, CASSONDRA TINA MARIE
Entity Type:Individual
Prefix:
First Name:CASSONDRA
Middle Name:TINA MARIE
Last Name:CHAGNON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6315 COUNCIL PT APT 204
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-5136
Mailing Address - Country:US
Mailing Address - Phone:916-952-5389
Mailing Address - Fax:
Practice Address - Street 1:6315 COUNCIL PT APT 204
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-5136
Practice Address - Country:US
Practice Address - Phone:916-952-5389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health