Individual
MISS CASSANDRA A RIDENOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN IL LCPC IL LMHC I
Contact information
Practice address
4455 E 56TH ST, DAVENPORT, IA 52807-2995
(563) 386-4004
Mailing address
4455 EAST 56TH STREET, DAVENPORT, IA 52807
(563) 386-4004
(563) 386-4026
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
001094
IA
104100000X
Social Worker
180006722
IL
Other
Enumeration date
05/19/2008
Last updated
05/19/2008
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