Provider Demographics
NPI:1154751816
Name:STREETER, CASSIE (LCSW)
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:STREETER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:
Other - Last Name:EIDEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:17952 LINWOOD CT
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-2122
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17952 LINWOOD CT
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55347-2122
Practice Address - Country:US
Practice Address - Phone:949-307-6272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-16
Last Update Date:2013-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNAP13-1551104100000X
CALCS 268891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker