Healthcare Provider Details

I. General information

NPI: 1962778803
Provider Name (Legal Business Name): CASSANDRA J GADDIS LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2012
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 SW MARTIN DR
TOPEKA KS
66609-1217
US

IV. Provider business mailing address

1320 NE 35TH ST TOPEKA, KS
TOPEKA KS
66617
US

V. Phone/Fax

Practice location:
  • Phone: 785-670-6178
  • Fax:
Mailing address:
  • Phone: 785-249-1782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: