Provider Demographics
NPI:1023493798
Name:AYUB, CASSANDRA LYNN MOORHEAD (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LYNN MOORHEAD
Last Name:AYUB
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 AMERICAN BLVD E
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1232
Mailing Address - Country:US
Mailing Address - Phone:952-737-6202
Mailing Address - Fax:612-728-5301
Practice Address - Street 1:1801 AMERICAN BLVD E
Practice Address - Street 2:SUITE 1
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-1232
Practice Address - Country:US
Practice Address - Phone:952-737-6202
Practice Address - Fax:612-728-5301
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN217921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical