Provider Demographics
NPI:1477271500
Name:GUTHRIE, CASSIDEE B (MS, LPC-IT)
Entity Type:Individual
Prefix:
First Name:CASSIDEE
Middle Name:B
Last Name:GUTHRIE
Suffix:
Gender:F
Credentials:MS, LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 N MCCARTHY RD APT 2
Mailing Address - Street 2:
Mailing Address - City:GRAND CHUTE
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8861
Mailing Address - Country:US
Mailing Address - Phone:224-688-9040
Mailing Address - Fax:
Practice Address - Street 1:1011 N LYNNDALE DR STE 2D
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-3091
Practice Address - Country:US
Practice Address - Phone:920-385-1420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7073-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health