Provider Demographics
NPI:1700396496
Name:PLAMBECK, KASSANDRA STEPHANIE (BA)
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:STEPHANIE
Last Name:PLAMBECK
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 29TH AVE SE APT E
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-2717
Mailing Address - Country:US
Mailing Address - Phone:650-274-6072
Mailing Address - Fax:
Practice Address - Street 1:201 E HENNEPIN AVE STE 206
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-1057
Practice Address - Country:US
Practice Address - Phone:612-587-2334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-07
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLIC408985225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist