Provider Demographics
NPI:1104211846
Name:ECKART, CASSANDRA CHRISTINE (BCABA)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:CHRISTINE
Last Name:ECKART
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7925 ORCHARD AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-2414
Mailing Address - Country:US
Mailing Address - Phone:715-923-3060
Mailing Address - Fax:
Practice Address - Street 1:7925 ORCHARD AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-2414
Practice Address - Country:US
Practice Address - Phone:715-923-3060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0-14-6419103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
0-14-6419OtherBEHAVIOR ANALYST CERTIFICATION BOARD