Provider Demographics
NPI:1649898636
Name:FRISQUE, CASSONDRA (MS, LPC, CSAC)
Entity type:Individual
Prefix:
First Name:CASSONDRA
Middle Name:
Last Name:FRISQUE
Suffix:
Gender:F
Credentials:MS, LPC, CSAC
Other - Prefix:
Other - First Name:CASSONDRA
Other - Middle Name:
Other - Last Name:STEELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:339 REED AVE
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-2020
Mailing Address - Country:US
Mailing Address - Phone:920-320-8600
Mailing Address - Fax:
Practice Address - Street 1:339 REED AVE
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-2020
Practice Address - Country:US
Practice Address - Phone:920-320-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18706101YA0400X
WI16562101YA0400X
WI4676101YM0800X
WI8635101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI8635-125OtherSTATE LICENSE
WI1649898636Medicaid
WI16562-131OtherSTATE LICENSE