Provider Demographics
NPI:1326639014
Name:JENNINGS, CASSANDRA (PSYD, HSPP)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:PSYD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6908 S OLD 41
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:IN
Mailing Address - Zip Code:47838-8384
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6908 S OLD 41
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:IN
Practice Address - Zip Code:47838-8384
Practice Address - Country:US
Practice Address - Phone:812-398-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20043224AOtherPROFESSIONAL LICENSE NUMBER