Provider Demographics
NPI:1376185967
Name:BADKE, CASSONDRA (LAPC)
Entity Type:Individual
Prefix:
First Name:CASSONDRA
Middle Name:
Last Name:BADKE
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:CASSONDRA
Other - Middle Name:
Other - Last Name:KRAMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 1ST ST SW STE 202
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-3851
Mailing Address - Country:US
Mailing Address - Phone:701-852-0836
Mailing Address - Fax:
Practice Address - Street 1:20 1ST ST SW STE 202
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-3851
Practice Address - Country:US
Practice Address - Phone:701-852-0836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-15
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
ND1294-6-1-23A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator