Provider Demographics
NPI:1710650056
Name:ROOK, CASSONDRA R
Entity Type:Individual
Prefix:
First Name:CASSONDRA
Middle Name:R
Last Name:ROOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CASSONDRA
Other - Middle Name:R
Other - Last Name:SIEBECKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2750 SUTTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-1093
Mailing Address - Country:US
Mailing Address - Phone:916-290-8130
Mailing Address - Fax:
Practice Address - Street 1:2750 SUTTERVILLE RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-1093
Practice Address - Country:US
Practice Address - Phone:916-290-8130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102660104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker