Provider Demographics
NPI:1619261740
Name:PECK, CASSIE MARGUERITE (LCSW-33434)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:MARGUERITE
Last Name:PECK
Suffix:
Gender:F
Credentials:LCSW-33434
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 205
Mailing Address - Street 2:
Mailing Address - City:BAYVIEW
Mailing Address - State:ID
Mailing Address - Zip Code:83803-0205
Mailing Address - Country:US
Mailing Address - Phone:208-255-6931
Mailing Address - Fax:208-209-6001
Practice Address - Street 1:231 N THIRD AVE
Practice Address - Street 2:STE 205
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1418
Practice Address - Country:US
Practice Address - Phone:208-255-6931
Practice Address - Fax:208-209-6001
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-334341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical