Provider Demographics
NPI:1306526793
Name:MENDENHALL, KASSANDRA SKYE (MSW, CSWA)
Entity type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:SKYE
Last Name:MENDENHALL
Suffix:
Gender:F
Credentials:MSW, CSWA
Other - Prefix:
Other - First Name:KASSANDRA
Other - Middle Name:
Other - Last Name:STATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:242 E WAYNO WAY
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-2660
Mailing Address - Country:US
Mailing Address - Phone:541-223-3783
Mailing Address - Fax:
Practice Address - Street 1:2645 PORTLAND RD NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-0198
Practice Address - Country:US
Practice Address - Phone:503-390-5637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health