Provider Demographics
NPI:1033507785
Name:DICKERSON, CASSANDRA
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 GLEN OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-1546
Mailing Address - Country:US
Mailing Address - Phone:712-222-1459
Mailing Address - Fax:712-222-1460
Practice Address - Street 1:700 4TH ST STE 220
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1702
Practice Address - Country:US
Practice Address - Phone:712-252-7170
Practice Address - Fax:712-252-1202
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA107652101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health