Provider Demographics
NPI:1952913758
Name:WENSTROM, CASSADY AYN
Entity Type:Individual
Prefix:
First Name:CASSADY
Middle Name:AYN
Last Name:WENSTROM
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 1:285 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-3501
Mailing Address - Country:US
Mailing Address - Phone:530-601-6685
Mailing Address - Fax:530-662-6918
Practice Address - Street 1:285 4TH ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3501
Practice Address - Country:US
Practice Address - Phone:530-662-2699
Practice Address - Fax:530-662-6918
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1232760616101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)