Provider Demographics
NPI:1245988930
Name:SALM, CASSIDY MICHAEL (LPC, SAC-IT)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:MICHAEL
Last Name:SALM
Suffix:
Gender:M
Credentials:LPC, SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 SYCAMORE DR # B32
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-5396
Mailing Address - Country:US
Mailing Address - Phone:920-286-2046
Mailing Address - Fax:
Practice Address - Street 1:4340 ELM LAWN RD
Practice Address - Street 2:
Practice Address - City:OCONTO FALLS
Practice Address - State:WI
Practice Address - Zip Code:54154-9656
Practice Address - Country:US
Practice Address - Phone:920-944-9373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19535-130101YA0400X
WI10869-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)