Healthcare Provider Details

I. General information

NPI: 1780431718
Provider Name (Legal Business Name): CASSANDRA MAY CARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 KELLY PL
WALLA WALLA WA
99362-8607
US

IV. Provider business mailing address

203 NE 7TH AVE
MILTON FREEWATER OR
97862-1721
US

V. Phone/Fax

Practice location:
  • Phone: 509-524-2920
  • Fax:
Mailing address:
  • Phone: 509-540-2954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: