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General NPI Number Information
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NPI Number | 1750001087
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Entity Type | Individual
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Provider Name | CASSANDRA MAE WICKETT
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Gender | Female
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Dates
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Enumeration Date | 08/29/2022
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 145 W 9TH STREET
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City | CASPER
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State | WY
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Zip | 82601
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Country | US
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Telephone | 307-215-1204
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1791 15 SAGE HILL ROAD
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City | GLENROCK
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State | WY
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Zip | 82637-1791
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Country | US
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Telephone | 307-262-8389
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State | WY
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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 | PPC-1391
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License Number State | WY
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-2402
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License Number State | WY
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