Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 7373-125 | WI |
NPI | 1003478793 |
---|---|
Provider Name | Cassandra Vanstraten |
First Address | Green Bay, WI 54303-1858 |
Second Address | Green Bay, WI 54303-1858 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2019 |
Last Update Date | 02/07/2019 |