Healthcare Provider Details

I. General information

NPI: 1396435764
Provider Name (Legal Business Name): CASSANDRA ANN FORSYTHE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 05/10/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 33RD AVE SW STE J
CEDAR RAPIDS IA
52404-4646
US

IV. Provider business mailing address

260 33RD AVE SW STE J
CEDAR RAPIDS IA
52404-4646
US

V. Phone/Fax

Practice location:
  • Phone: 319-361-6529
  • Fax:
Mailing address:
  • Phone: 319-361-6529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number120468
License Number StateIA

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: