Provider Demographics
NPI:1215383195
Name:PRIEKSAT, CASSANDRA (CADC TEMP)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:PRIEKSAT
Suffix:
Gender:F
Credentials:CADC TEMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 LINCOLN ST SE
Mailing Address - Street 2:
Mailing Address - City:LE MARS
Mailing Address - State:IA
Mailing Address - Zip Code:51031-3645
Mailing Address - Country:US
Mailing Address - Phone:712-546-7868
Mailing Address - Fax:
Practice Address - Street 1:19 LINCOLN ST SE
Practice Address - Street 2:
Practice Address - City:LE MARS
Practice Address - State:IA
Practice Address - Zip Code:51031-3645
Practice Address - Country:US
Practice Address - Phone:712-546-7868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAT16068101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)