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General NPI Number Information
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NPI Number | 1255644753
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Entity Type | Individual
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Provider Name | JESSACA ANN CASSADY LCSW, LAC
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Gender | Female
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Dates
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Enumeration Date | 07/26/2010
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Last Update Date | 12/01/2022
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Provider Practice Location Address
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Address Line | 1328 COUNTY ROAD 501
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City | BAYFIELD
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State | CO
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Zip | 81122
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Country | US
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Telephone | 970-903-3354
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Fax | 970-884-5004
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Provider Business Mailing Address
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Address Line | 3696 COUNTY ROAD 502
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City | BAYFIELD
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State | CO
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Zip | 81122-9016
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Country | US
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Telephone | 970-903-3354
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Fax | 970-884-5004
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW-1610
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | ACD-0639
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License Number State | CO
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