Basic Information
| Provider Information | |||||||||
| NPI: | 1568821767 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NIEMAN | ||||||||
| FirstName: | CASSIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 W BROADWAY AVE | ||||||||
| Address2: | SUITES 2 AND 3 | ||||||||
| City: | FOREST LAKE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550251175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512515226 | ||||||||
| FaxNumber: | 6512515279 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 W BROADWAY AVE | ||||||||
| Address2: | SUITES 2 AND 3 | ||||||||
| City: | FOREST LAKE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550251175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512515226 | ||||||||
| FaxNumber: | 6512515279 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2016 | ||||||||
| LastUpdateDate: | 02/16/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.