Healthcare Provider Details

I. General information

NPI: 1881953446
Provider Name (Legal Business Name): CASSANDRA A WICHLENSKI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CASSANDRA A CAMPBELL

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9804 MANCHESTER RD STE B
SAINT LOUIS MO
63119-1210
US

IV. Provider business mailing address

1740 STIFEL LANE DR
CHESTERFIELD MO
63017-8047
US

V. Phone/Fax

Practice location:
  • Phone: 314-706-1562
  • Fax: 636-333-4510
Mailing address:
  • Phone: 314-255-6360
  • Fax: 636-333-4510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number004496
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: