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Individual

MRS. CASSIE ANN ICENOGLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LMHC

Contact information

Practice address
6326 MARTIN WAY E STE 200, LACEY, WA 98516-5570
(360) 506-4886
(360) 878-8536
Mailing address
PO BOX 5153, LACEY, WA 98509-5153
(360) 506-4886
(360) 878-8536

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
DEVDREELOO
01
01
DEVDREWLOO
01
Enumeration date
07/25/2018
Last updated
09/08/2021
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