Healthcare Provider Details

I. General information

NPI: 1174432322
Provider Name (Legal Business Name): CASSIDY LYNN MOHLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 PARK 3RD AVENUE NW APARTMENT 17
WAVERLY IA
50677
US

IV. Provider business mailing address

2505 PARK 3RD AVENUE NW APARTMENT 17
WAVERLY IA
50677
US

V. Phone/Fax

Practice location:
  • Phone: 563-387-7971
  • Fax:
Mailing address:
  • Phone: 563-387-7971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: