Provider Demographics
NPI:1316121676
Name:CASSUTT, JAMIE A
Entity type:Individual
Prefix:MISS
First Name:JAMIE
Middle Name:A
Last Name:CASSUTT
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 1:12519 SW ORCHARD HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-1116
Mailing Address - Country:US
Mailing Address - Phone:505-670-1081
Mailing Address - Fax:
Practice Address - Street 1:12519 SW ORCHARD HILL RD
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-1116
Practice Address - Country:US
Practice Address - Phone:505-670-1081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor