Healthcare Provider Details

I. General information

NPI: 1144966326
Provider Name (Legal Business Name): KASSANDRA D PADGET LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1527 ALBIA RD
OTTUMWA IA
52501-3907
US

IV. Provider business mailing address

1527 ALBIA RD
OTTUMWA IA
52501-3907
US

V. Phone/Fax

Practice location:
  • Phone: 641-682-8772
  • Fax: 641-682-1924
Mailing address:
  • Phone: 641-682-8772
  • Fax: 641-682-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number113427
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: