Provider Demographics
NPI:1538830674
Name:WAGES, CASSAUNDRA MAXINE
Entity type:Individual
Prefix:
First Name:CASSAUNDRA
Middle Name:MAXINE
Last Name:WAGES
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 1:1622 BARTOW RD
Mailing Address - Street 2:
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-4309
Mailing Address - Country:US
Mailing Address - Phone:707-862-6662
Mailing Address - Fax:
Practice Address - Street 1:1622 BARTOW RD
Practice Address - Street 2:
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519-4309
Practice Address - Country:US
Practice Address - Phone:707-862-6662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician