Active NPI
Cassandra A Heideman, LPC-IT, SAC-IT
- Mental Health Counselor
- Mauston, WI
National Provider Identifier
1053876532
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 4750-226
- Practice address
- 200 Hickory Street
Mauston, WI 53948 - Phone
- (608) 847-2400
- Fax
- (608) 847-9599
- NPI assigned
- Feb 8, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 18776-130 | WI | |
| Mental Health Counselor | 101YM0800X | 4750-226 | WI | Primary |
Addresses
Primary practice location
200 Hickory Street
Mauston, WI 53948
Mailing address
200 Hickory Street
Mauston, WI 53948
Phone (608) 847-2400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18776-130 | WI | MD | Addiction (Substance Use Disorder) Counselor |
| 4750-226 | WI | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1549584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601337600000",
"number": "1053876532",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 HICKORY STREET",
"city": "MAUSTON",
"state": "WI",
"postal_code": "53948",
"telephone_number": "608-847-2400",
"fax_number": "608-847-9599"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 HICKORY STREET",
"city": "MAUSTON",
"state": "WI",
"postal_code": "53948",
"telephone_number": "608-847-2400",
"fax_number": "608-847-9599"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEIDEMAN",
"first_name": "CASSANDRA",
"middle_name": "A",
"name_prefix": "Ms.",
"credential": "LPC-IT, SAC-IT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-02-08",
"last_updated": "2020-09-29",
"certification_date": "2020-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WI",
"license": "18776-130",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WI",
"license": "4750-226",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mauston, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.