Healthcare Provider Details

I. General information

NPI: 1043851603
Provider Name (Legal Business Name): CASSIE MORTENSEN LPC, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2019
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E MAIN ST STE 4
WAUNAKEE WI
53597-1196
US

IV. Provider business mailing address

101 E MAIN ST STE 4
WAUNAKEE WI
53597-1196
US

V. Phone/Fax

Practice location:
  • Phone: 608-285-2131
  • Fax: 608-850-9315
Mailing address:
  • Phone: 608-285-2131
  • Fax: 608-850-9315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number319-140
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8716
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: