Provider Demographics
NPI:1689313785
Name:NOLAN, CASSANDRA NICOLE
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:NICOLE
Last Name:NOLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17823 W SHELTERED CT
Mailing Address - Street 2:
Mailing Address - City:HAUSER
Mailing Address - State:ID
Mailing Address - Zip Code:83854-7818
Mailing Address - Country:US
Mailing Address - Phone:209-620-9998
Mailing Address - Fax:
Practice Address - Street 1:104 S FREYA ST
Practice Address - Street 2:BLUE FLAG BUILDING, SUITE 206
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-4889
Practice Address - Country:US
Practice Address - Phone:208-639-9148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMFTA.MG.61298775106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMFTA.MG.61298775OtherWASHINGTON DEPARTMENT OF HEALTH