Healthcare Provider Details

I. General information

NPI: 1699692293
Provider Name (Legal Business Name): CASSIDY N BENNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 3RD AVE NE UNIT A
DEVILS LAKE ND
58301-2118
US

IV. Provider business mailing address

818 3RD AVE NE UNIT A
DEVILS LAKE ND
58301-2118
US

V. Phone/Fax

Practice location:
  • Phone: 712-308-1771
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: