Healthcare Provider Details

I. General information

NPI: 1033098678
Provider Name (Legal Business Name): CASSIDI K. STUCKMAN LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2975 VALMONT RD
BOULDER CO
80301-1361
US

IV. Provider business mailing address

370 20TH ST
BOULDER CO
80302-8011
US

V. Phone/Fax

Practice location:
  • Phone: 785-770-2879
  • Fax:
Mailing address:
  • Phone: 785-770-2879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC.0022111
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: