Provider Demographics
NPI:1396435764
Name:FORSYTHE, CASSANDRA ANN
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:ANN
Last Name:FORSYTHE
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 1:260 33RD AVE SW STE J
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-4646
Mailing Address - Country:US
Mailing Address - Phone:319-361-6529
Mailing Address - Fax:
Practice Address - Street 1:260 33RD AVE SW STE J
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-4646
Practice Address - Country:US
Practice Address - Phone:319-361-6529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA101YM0800X
IA120468101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty