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NPI Code Detail

MEDICARE: CASSANDRA HENRICHSEN RBT

MEDICARE: CASSANDRA HENRICHSEN RBT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician18-72223AZ

General Provider Information

NPI Number : 1255956165
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASSANDRA HENRICHSEN RBT
Provider Business Mailing Address
First Line : 4170 N 108TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85037-5469
Country : US
Telephone Number : 480-751-1957
Fax Number : 832-383-8823
Provider Business Practice Location Address
First Line : 4170 N 108TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85037-5469
Country : US
Telephone Number : 480-751-1957
Fax Number : 832-383-8823
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2020
Last Update Date : 06/16/2020

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Directions to “ CASSANDRA HENRICHSEN RBT” Practice Location

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