Provider Demographics
NPI:1891272506
Name:ICENOGLE, CASSIE ANN (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:CASSIE
Middle Name:ANN
Last Name:ICENOGLE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5153
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98509-5153
Mailing Address - Country:US
Mailing Address - Phone:360-506-4886
Mailing Address - Fax:360-878-8536
Practice Address - Street 1:6326 MARTIN WAY E STE 200
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-5570
Practice Address - Country:US
Practice Address - Phone:360-506-4886
Practice Address - Fax:360-878-8536
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEVDREELOOOther01
DEVDREWLOOOther01