Healthcare Provider Details

I. General information

NPI: 1982937348
Provider Name (Legal Business Name): CASSANDRA COLEMAN-HEPPLER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E ANTON AVE STE 206
COEUR D ALENE ID
83815-3727
US

IV. Provider business mailing address

12128 N DIVISION ST # 441
SPOKANE WA
99218-1905
US

V. Phone/Fax

Practice location:
  • Phone: 208-667-6095
  • Fax: 208-667-6173
Mailing address:
  • Phone: 509-990-6560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMSW-25735
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW31144
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60231336
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: