Provider Demographics
NPI:1922746668
Name:STAPLES, CASSY MARIA
Entity Type:Individual
Prefix:
First Name:CASSY
Middle Name:MARIA
Last Name:STAPLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CASSY
Other - Middle Name:MARIA
Other - Last Name:LOGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1104 SE 771ST RD
Mailing Address - Street 2:
Mailing Address - City:LEETON
Mailing Address - State:MO
Mailing Address - Zip Code:64761-8158
Mailing Address - Country:US
Mailing Address - Phone:660-864-5184
Mailing Address - Fax:
Practice Address - Street 1:1104 SE 771ST RD
Practice Address - Street 2:
Practice Address - City:LEETON
Practice Address - State:MO
Practice Address - Zip Code:64761-8158
Practice Address - Country:US
Practice Address - Phone:816-469-5612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician