Provider Demographics
NPI:1629474275
Name:UGALDE, KASSANDRA (CPC)
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:
Last Name:UGALDE
Suffix:
Gender:F
Credentials:CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11240 FIR DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506-8956
Mailing Address - Country:US
Mailing Address - Phone:775-530-0726
Mailing Address - Fax:
Practice Address - Street 1:2125 GREEN VISTA DR STE 106
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-8515
Practice Address - Country:US
Practice Address - Phone:775-530-0726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND800-8-15-14A101YP2500X
NVCP1262-R101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional