Provider Demographics
NPI:1558864900
Name:JAHN, CASSSANDRA LYNN (DC, AFC OWNER)
Entity Type:Individual
Prefix:MRS
First Name:CASSSANDRA
Middle Name:LYNN
Last Name:JAHN
Suffix:
Gender:F
Credentials:DC, AFC OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2645 146TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:HAM LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55304-6420
Mailing Address - Country:US
Mailing Address - Phone:612-578-3602
Mailing Address - Fax:
Practice Address - Street 1:2645 146TH AVE NE
Practice Address - Street 2:
Practice Address - City:HAM LAKE
Practice Address - State:MN
Practice Address - Zip Code:55304-6420
Practice Address - Country:US
Practice Address - Phone:612-578-3602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1092159-1-HCBS253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency