Provider Demographics
NPI:1598883282
Name:EDBLAD, CASSANDRA MICHELLE
Entity Type:Individual
Prefix:MISS
First Name:CASSANDRA
Middle Name:MICHELLE
Last Name:EDBLAD
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CASSANDRA
Other - Middle Name:MICHELLE
Other - Last Name:EGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6721 CALIFORNIA CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:93505-1745
Mailing Address - Country:US
Mailing Address - Phone:760-373-8086
Mailing Address - Fax:
Practice Address - Street 1:8108 BAY AVE
Practice Address - Street 2:
Practice Address - City:CALIFORNIA CITY
Practice Address - State:CA
Practice Address - Zip Code:93505-2656
Practice Address - Country:US
Practice Address - Phone:760-373-2979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor