Provider Demographics
NPI:1770145658
Name:CASSON, LINDA
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:CASSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 CHINABERRY DR STE 902
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2455
Mailing Address - Country:US
Mailing Address - Phone:318-742-3408
Mailing Address - Fax:318-841-1210
Practice Address - Street 1:305 S HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:MANY
Practice Address - State:LA
Practice Address - Zip Code:71449-3719
Practice Address - Country:US
Practice Address - Phone:318-256-5200
Practice Address - Fax:318-256-5201
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator