Healthcare Provider Details

I. General information

NPI: 1215776570
Provider Name (Legal Business Name): CASSIDY JADE WURTZBURGER MS PSYCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2024
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 N CHESTNUT ST SUITE 301
SEYMOUR IN
47274-2197
US

IV. Provider business mailing address

113 N CHESTNUT ST
SEYMOUR IN
47274-2176
US

V. Phone/Fax

Practice location:
  • Phone: 812-515-3160
  • Fax:
Mailing address:
  • Phone: 812-515-3160
  • 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: