Provider Demographics
NPI:1659090447
Name:PRALLE, CASSANDRA ANNETTE
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:ANNETTE
Last Name:PRALLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:ANNETTE
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:W1818 DAVIS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MINDORO
Mailing Address - State:WI
Mailing Address - Zip Code:54644-9416
Mailing Address - Country:US
Mailing Address - Phone:608-386-4160
Mailing Address - Fax:608-615-1063
Practice Address - Street 1:605 4TH ST S
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-4458
Practice Address - Country:US
Practice Address - Phone:608-386-4160
Practice Address - Fax:608-615-1063
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI132767-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker