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General NPI Number Information
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NPI Number | 1245988930
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Entity Type | Individual
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Provider Name | CASSIDY MICHAEL SALM LPC, SAC-IT
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Gender | Male
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Dates
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Enumeration Date | 03/12/2022
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Last Update Date | 03/12/2024
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Provider Practice Location Address
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Address Line | 4340 ELM LAWN RD
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City | OCONTO FALLS
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State | WI
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Zip | 54154-9656
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Country | US
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Telephone | 920-944-9373
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Fax |
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Provider Business Mailing Address
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Address Line | 2420 SYCAMORE DR # B32
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City | GREEN BAY
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State | WI
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Zip | 54311-5396
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Country | US
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Telephone | 920-286-2046
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 19535-130
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 10869-125
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License Number State | WI
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