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General NPI Number Information
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NPI Number | 1659090447
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Entity Type | Individual
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Provider Name | CASSANDRA ANNETTE PRALLE
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Gender | Female
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Dates
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Enumeration Date | 08/24/2022
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Last Update Date | 08/24/2022
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Provider Practice Location Address
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Address Line | 605 4TH ST S
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City | LA CROSSE
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State | WI
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Zip | 54601-4458
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Country | US
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Telephone | 608-386-4160
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Fax | 608-615-1063
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Provider Business Mailing Address
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Address Line | W1818 DAVIS CREEK RD
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City | MINDORO
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State | WI
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Zip | 54644-9416
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Country | US
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Telephone | 608-386-4160
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Fax | 608-615-1063
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 132767-121
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License Number State | WI
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