Healthcare Provider Details

I. General information

NPI: 1437086238
Provider Name (Legal Business Name): CASSIDY SHANAE JIMERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W 2ND ST STE A
SALIDA CO
81201-2046
US

IV. Provider business mailing address

630 W 14TH ST
SALIDA CO
81201-1808
US

V. Phone/Fax

Practice location:
  • Phone: 719-626-1289
  • Fax:
Mailing address:
  • Phone: 970-580-1618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: