Provider Demographics
NPI:1669708046
Name:TRENHAILE, CASSIE JO (LAC)
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:JO
Last Name:TRENHAILE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2724 GARFIELD AVE
Mailing Address - Street 2:#1
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-1344
Mailing Address - Country:US
Mailing Address - Phone:612-790-5505
Mailing Address - Fax:
Practice Address - Street 1:1036 CLEVELAND AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1826
Practice Address - Country:US
Practice Address - Phone:612-790-5505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1465171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist