Active NPI
Cassandra A Ridenour, RN IL LCPC IL LMHC I
- Social Worker
- Davenport, IA
National Provider Identifier
1144487182
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 001094
- Practice address
- 4455 E 56TH St
Davenport, IA 52807-2995 - Phone
- (563) 386-4004
- NPI assigned
- May 19, 2008
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 001094 | IA | Primary |
| Social Worker | 104100000X | 180006722 | IL |
Addresses
Primary practice location
4455 E 56TH St
Davenport, IA 52807-2995
Mailing address
4455 East 56TH Street
Davenport, IA 52807
Phone (563) 386-4004
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180006722 | IL | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211155200000",
"number": "1144487182",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4455 EAST 56TH STREET",
"city": "DAVENPORT",
"state": "IA",
"postal_code": "52807",
"telephone_number": "563-386-4004",
"fax_number": "563-386-4026"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4455 E 56TH ST",
"city": "DAVENPORT",
"state": "IA",
"postal_code": "528072995",
"telephone_number": "563-386-4004"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIDENOUR",
"first_name": "CASSANDRA",
"middle_name": "A",
"name_prefix": "Miss",
"credential": "RN IL LCPC IL LMHC I",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-05-19",
"last_updated": "2008-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IA",
"license": "001094",
"primary": true
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IL",
"license": "180006722",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Davenport, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.