Provider Demographics
NPI:1962564740
Name:LEE, CASSANDRA YUSOOK (LICSW)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:YUSOOK
Last Name:LEE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16561
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-0561
Mailing Address - Country:US
Mailing Address - Phone:651-775-5693
Mailing Address - Fax:651-602-9770
Practice Address - Street 1:7630 145TH ST W STE 218
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7553
Practice Address - Country:US
Practice Address - Phone:651-775-5693
Practice Address - Fax:651-602-9770
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN129661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical