Healthcare Provider Details

I. General information

NPI: 1588230916
Provider Name (Legal Business Name): CASSANDRA NOE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N VANDEMARK RD
SIDNEY OH
45365-3567
US

IV. Provider business mailing address

600 WALNUT ST
GREENVILLE OH
45331-1944
US

V. Phone/Fax

Practice location:
  • Phone: 937-622-7393
  • Fax:
Mailing address:
  • Phone: 937-548-6842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDCII161971
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: