Provider Demographics
NPI:1780050153
Name:CASSON, JACIE ANN (MSW)
Entity type:Individual
Prefix:
First Name:JACIE
Middle Name:ANN
Last Name:CASSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 S TAMARAC DR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4360
Mailing Address - Country:US
Mailing Address - Phone:720-353-0022
Mailing Address - Fax:
Practice Address - Street 1:3201 S TAMARAC DR
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-4360
Practice Address - Country:US
Practice Address - Phone:720-353-0022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9147539Medicaid